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Reducing Readmissions in Community-Acquired Pneumonia

Reducing Readmissions in Community-Acquired Pneumonia

In the United States, community-acquired pneumonia (CAP) is the leading cause of morbidity and mortality due to infection and most often strikes the elderly and individuals with comorbidities. The 30-day mortality rate for Medicare patients admitted to the hospital for CAP is about 12% and has not changed significantly in decades (Table 1). CAP has been shown to increase long-term mortality to as high as 40% within 1 year of admission. The infection is one of seven conditions that account for nearly 30% of potentially preventable readmissions in the 15-day window after initial hospital discharge. Estimates show that the cost of treating CAP exceeds $17 billion per year. Hospitalizing Patients With Community-Acquired Pneumonia “The decision on whether or not hospitalization is necessary for CAP is critical because there are multiple consequences,” says Thomas M. File, Jr., MD, MSc. “Hospitalizations can influence the cost of care, the intensity of diagnostic testing, and the selection of antimicrobial agents.” There are several advantages to outpatient treatment of CAP—when used appropriately—including cost, patient preference, faster convalescence, and fewer nosocomial complications. Hospitalization decisions should be based on several factors, including (among others): age over 50; significant underlying coexisting conditions; elevated blood urea nitrogen levels; and the presence of altered mental status or significant abnormalities in vital signs. “Readmission for CAP patients recently discharged after hospitalization represents an important, expensive, and often preventable adverse outcome,” Dr. File says. “The risk of readmission can be modified by the quality and type of care that is provided. Improving CAP readmission rates is the joint responsibility of hospitals and clinicians.” He adds that measuring readmission rates can help...

A Look at Near-Miss Mortality and Morbidity in Pregnancy

Previous research suggests that timely delivery of appropriate healthcare services may prevent almost half of all pregnancy-related deaths in the United States. Although maternal deaths are increasingly attributed to preexisting condi­tions, the relative effect of these conditions and the extent to which maternal morbidity and mortality are concentrated in high-risk patients have not been well defined. Focusing on Near-Miss Pregnancy Events Jill M. Mhyre, MD, and colleagues had a study published in the November 2011 issue of Anesthesiology that sought to iden­tify which preexisting conditions predicted maternal morbidity, mortality, and “near- miss” events. A near miss occurs when preg­nant women or recently postpartum women survive a life-threatening event, either because of high-quality medical care or by chance alone. “In our study, we investigated women who died as well as those who sur­vived an event in the hopes of uncovering important lessons with regard to predicting outcomes and preventing progression from near misses to death,” says Dr. Mhyre. A near miss was defined as end-organ injury that impacted hospital discharge. The highest rates of near-miss morbidity or mortality events were found among women with pulmonary hypertension (PH), malig­nancy, and systemic lupus erythematosus (Table). Advancing maternal age and non-white race also increased risk for near-miss morbidity or mortality. “While the effect sizes we observed for age and race were relatively modest when compared with certain medical conditions, these effects remained statistically significant even after controlling for all other medical and obstet­ric conditions,” Dr. Mhyre says. “The abso­lute rate per thousand deliveries increased three-fold when age older than 40 was com­pared with ages 20 to 34, but the adjusted odds ratio was...

The Effect of Pregnancy on Common Surgeries

Postoperative maternal morbidity after appendectomy and cholecystectomy does not appear to be increased with pregnancy, according to a review of data from the National Surgical Quality Improvement Program. The analysis found that composite 30-day major morbidity rates were 3.9% and 3.1% for pregnant and non-pregnant women, respectively, following appendectomy. Following cholecystectomy, the morbidity rate was 1.8% for both pregnant and non-pregnant women. Abstract: Obstetrics & Gynecology, December...
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