The Revolving Door: A Report on U.S. Hospital Readmissions

The U.S. health care system suffers from a chronic malady -- the revolving door syndrome at its hospitals. It is so bad that the federal government says one in five elderly patients is back in the hospital within 30 days of leaving.Some return trips are predictable elements of a treatment plan. Others are unplanned but difficult to prevent: patients go home, new and unexpected problems arise, and they require an immediate trip back to the hospital.But many of these readmissions can and should be prevented. They are the result of a fragmented system of care that too often leaves discharged patients to their own devices, unable to follow instructions they didn't understand, and not taking medications or getting the necessary follow-up care.The federal government has pegged the cost of readmissions for Medicare patients alone at $26 billion annually, and says more than$17 billion of it pays for return trips that need not happen if patients get the right care. This is one reason the Centers for Medicare & Medicaid Services has identified avoidable readmissions as one of the leading problems facing the U.S. health care system and now penalizes hospitals with high rates of readmissions for their heart failure, heart attack, and pneumonia patients. This report is being released in conjunction with the Robert Wood John Foundation's Care About Your Care initiative, which is devoted to improving care transitions when people leave the hospital. It looks at the issue of readmissions in two ways: by the numbers and through the eyes of the people who live them

Our Parents, Ourselves: Health Care for an Aging Population; A Report of the Dartmouth Atlas Project

The new Dartmouth Atlas, funded by The John A. Hartford Foundation, is a report card that analyzes Medicare data to show us where the United States is making progress in patient-centered, evidence-based care for Medicare beneficiaries and where improvement is still needed. It also offers insight into regional variations in care.Filling in the gaps in our knowledge about the state of care across the country will help health care providers, health systems, and patients and families work together to improve care for all older adults.This Dartmouth Atlas report looks at a number of measures from Medicare data, including:The number of days older adults spend in contact with the health care system;Use of high-risk medications;Cancer screening rates (and how they compare with recommendations);30-day hospital readmission rates;Annual Wellness Visit (AWV) rates;Late hospice referral; andThe number of days spent in intensive care.The report also offers a historical look at key practices, comparing data from 2003-05 and 2012

Testing the Non-universal Z^\prime Model in Bs -> \phi \pi^0 Decay

The branching ratio and direct CP asymmetry of the decay mode $B_s \to \phi \pi^0$ have been calculated within the QCD factorization approach in both the standard model (SM) and the non-universal $Z^\prime$ model. In the standard model, the CP averaged branching ratio is about $1.3\times 10^{-7}$. Considering the effect of $Z^\prime$ boson, we found the branching ratio can be enlarged three times or decreased to one third %by the effect of $Z^\prime$ boson within the allowed parameter spaces. Furthermore, the direct CP asymmetry could reach 55% with a light $Z^\prime$ boson and suitable CKM phase, compared to 25% predicted in the SM. The enhancement of both branching ratio and CP asymmetry cannot be realized at the same parameter spaces, thus, if this decay mode is measured in the upcoming LHC-b experiment and/or Super B-factories, the peculiar deviation from the SM may provide a signal of the non-universal $Z^\prime$ model, which can be used to constrain the mass of $Z^\prime$ boson in turn.Comment: 9 pages, 5 figure

BLIP-Adapter: Parameter-Efficient Transfer Learning for Mobile Screenshot Captioning

This study aims to explore efficient tuning methods for the screenshot captioning task. Recently, image captioning has seen significant advancements, but research in captioning tasks for mobile screens remains relatively scarce. Current datasets and use cases describing user behaviors within product screenshots are notably limited. Consequently, we sought to fine-tune pre-existing models for the screenshot captioning task. However, fine-tuning large pre-trained models can be resource-intensive, requiring considerable time, computational power, and storage due to the vast number of parameters in image captioning models. To tackle this challenge, this study proposes a combination of adapter methods, which necessitates tuning only the additional modules on the model. These methods are originally designed for vision or language tasks, and our intention is to apply them to address similar challenges in screenshot captioning. By freezing the parameters of the image caption models and training only the weights associated with the methods, performance comparable to fine-tuning the entire model can be achieved, while significantly reducing the number of parameters. This study represents the first comprehensive investigation into the effectiveness of combining adapters within the context of the screenshot captioning task. Through our experiments and analyses, this study aims to provide valuable insights into the application of adapters in vision-language models and contribute to the development of efficient tuning techniques for the screenshot captioning task. Our study is available at https://github.com/RainYuGG/BLIP-Adapte

Trends and Variation in End-of-Life Care for Medicare Beneficiaries With Severe Chronic Illness

Provides an updated analysis of regional and hospital variations in end-of-life care for Medicare beneficiaries with chronic illnesses, including percentage of hospital deaths, days in intensive care units, and physician labor per patient

Medicare beneficiary panel characteristics associated with high Part D biologic disease-modifying anti-rheumatic drug prescribing for older adults among rheumatologists.

ABSTRACT: The aim of this study was to investigate beneficiary panel characteristics associated with rheumatologists' prescribing of biologic DMARDs (bDMARDs) for older adults.In this retrospective observational study, we used Medicare Public Use Files (PUFs) to identify rheumatologists who met criteria for high-prescribing, defined as bDMARD prescription constituting ≥20% of their DMARD claims for beneficiaries ≥65 years of age. We first used descriptive analysis then multivariable regression model to test the association of high prescribing of bDMARDs with rheumatologists' panel size and beneficiary characteristics. In particular, we quantified the proportion of panel beneficiaries ≥75 years of age to assess how caring for an older panel correlate with prescribing of bDMARDs.We identified 3197 unique rheumatologists, of whom 405 (13%) met criteria for high prescribing of bDMARDs for Medicare beneficiaries ≥65 years of age. The high-prescribers provided care to 12% of study older adults, and yet accounted for 21% of bDMARD prescriptions for them. High prescribing of bDMARDs was associated with smaller panel size, and their beneficiaries were more likely to be non-black, ≥75 years of age, non-dual eligible, have diagnosis of CHF, however, less likely to have CKD.Rheumatologists differ in their prescribing of bDMARDs for older adults, and those caring for more beneficiaries ≥75 years of age are more likely to be high-prescribers. Older adults are more prone to the side-effects of bDMARDs and further investigation is warranted to understand drivers of differential prescribing behaviors to optimize use of these high-risk and high-cost medications.http://deepblue.lib.umich.edu/bitstream/2027.42/170715/2/Medicare beneficiary panel characteristics associated with high Part D biologic disease-modifying anti-rheumatic drug prescr.pdfPublished versio

Health System Characteristics and Rates of Readmission After Acute Myocardial Infarction in the United States

Background: Interventions to reduce early readmissions have focused on patient characteristics and the importance of early follow‐up; however, less is known about the characteristics of health systems, including quality, capacity, and intensity, and their influence on readmission rates in the United States. Therefore, we examined the association of hospital patterns of medical care with rates of 30‐day readmission. Methods and Results: Medicare beneficiaries hospitalized for an AMI (n=188 611) between 2008 and 2009 in 1088 hospitals in the United States were included in our cohort. We tested the association between hospital patterns of medical care quality (discharge planning care quality), capacity (hospital size measured as the number of beds, hospital‐level Medicare all medical admission rates, supply of primary care physicians and cardiologists), and intensity (measures of care during the last 6 months of life) on CMS risk‐adjusted rates of 30‐day readmission using Poisson multilevel mixed‐effects models adjusting for patient‐ and hospital‐level covariates. There were 38 350 readmissions at 30‐days (20.3%) AMI discharges. Controlling for patient characteristics, measures of hospital care associated with higher rates of readmission included higher hospital‐level rates for all medical admissions, per capita primary care physicians and cardiologists, and last 6 months of life care intensity measures including increased number of hospital days, number of ICU days, number of physician visits, and 10 or more different physicians seen during the last 6 months of life. Better discharge quality and larger hospitals were associated with lower rates of readmission. Conclusions: In addition to quality of care, high 30‐day readmission rates are associated with hospital‐level measures of capacity and intensity. Efforts to reduce readmission rates may need to address these broader patterns of medical care

Association of Receiving Multiple, Concurrent Fracture-Associated Drugs With Hip Fracture Risk

Importance: Many prescription drugs increase fracture risk, which raises concern for patients receiving 2 or more such drugs concurrently. Logic suggests that risk will increase with each additional drug, but the risk of taking multiple fracture-associated drugs (FADs) is unknown. Objective: To estimate hip fracture risk associated with concurrent exposure to multiple FADs. Design, Setting, and Participants: This cohort study used a 20% random sample of Medicare fee-for-service administrative data for age-eligible Medicare beneficiaries from 2004 to 2014. Sex-stratified Cox regression models estimated hip fracture risk associated with current receipt of 1, 2, or 3 or more of 21 FADs and, separately, risk associated with each FAD and 2-way FAD combination vs no FADs. Models included sociodemographic characteristics, comorbidities, and use of non-FAD medications. Analyses began in November 2018 and were completed April 2019. Exposure: Receipt of prescription FADs. Main Outcomes and Measures: Hip fracture hospitalization. Results: A total of 11.3 million person-years were observed, reflecting 2,646,255 individuals (mean [SD] age, 77.2 [7.3] years, 1,615,613 [61.1%] women, 2,136,585 [80.7%] white, and 219 579 [8.3%] black). Overall, 2,827,284 person-years (25.1%) involved receipt of 1 FAD; 1,322,296 (11.7%), 2 FADs; and 954,506 (8.5%), 3 or more FADs. In fully adjusted, sex-stratified models, an increase in hip fracture risk among women was associated with the receipt of 1, 2, or 3 or more FADs (1 FAD: hazard ratio [HR], 2.04; 95% CI, 1.99-2.11; P\u3c.001; 2 FADs: HR, 2.86; 95% CI, 2.77-2.95; P\u3c.001; ≥3 FADs: HR, 4.50; 95% CI, 4.36-4.65; P\u3c.001). Relative risks for men were slightly higher (1 FAD: HR, 2.23; 95% CI, 2.11-2.36; P\u3c.001; 2 FADs: HR, 3.40; 95% CI, 3.20-3.61; P\u3c.001; ≥3 FADs: HR, 5.18; 95% CI, 4.87-5.52; P\u3c.001). Among women, 2 individual FADs were associated with HRs greater than 3.00; 80 pairs of FADs exceeded this threshold. Common, risky pairs among women included sedative hypnotics plus opioids (HR, 4.90; 95% CI, 3.98-6.02; P\u3c.001), serotonin reuptake inhibitors plus benzodiazepines (HR, 4.50; 95% CI, 3.76-5.38; P\u3c.001), and proton pump inhibitors plus opioids (HR, 4.00; 95% CI, 3.56-4.49; P\u3c.001). Receipt of 1, 2, or 3 or more non-FADs was associated with a small, significant reduction in fracture risk compared with receipt of no non-FADs among women (1 non-FAD: HR, 0.93; 95% CI, 0.90-0.96; P\u3c.001; 2 non-FADs: HR, 0.84; 95% CI, 0.81-0.87; P\u3c.001; ≥3 non-FADs: HR, 0.74; 95% CI, 0.72-0.77; P\u3c.001). Conclusions and Relevance: Among older adults, FADs are commonly used and commonly combined. In this cohort study, the addition of a second and third FAD was associated with a steep increase in fracture risk. Many risky pairs of FADs included potentially avoidable drugs (eg, sedatives and opioids). If confirmed, these findings suggest that fracture risk could be reduced through tighter adherence to long-established prescribing guidelines and recommendations