Background: Poor coordination between hospital and outpatient care worsens health outcomes, and increases preventable hospitalization and health care expenditures, especially for socioeconomically disadvantaged populations. Evidence of the effects of current programs to improve care coordination is mixed, and there is little data on how their impact may differ for hospitalizations for ambulatory care-sensitive conditions (ACSCs) [...]

Background: Higher rates of 30-day readmissions are associated with lower quality hospital care, and readmissions may put patients at risk for worse health outcomes including death. Historically, 20% of hospitalized Medicare beneficiaries were readmitted within 30 days, and many readmissions appeared avoidable. Accordingly, the Centers for Medicare and Medicaid Services (CMS) implemented the Hospital Readmissions [...]

Background: The United States sees over 35 million hospital discharges a year with a 20% readmission rate. Unplanned readmissions amount to 20 billion dollars annually. Efforts to prevent readmissions impact patient’s overall morbidity/mortality and alleviate the financial burden on health care systems. To that effect, the United States health care reform, under the Affordable Care [...]

Background: Medicare Advantage (MA) plans have strong incentives to reduce potentially wasteful healthcare, including costly acute care visits for ambulatory care-sensitive conditions (ACSC) [1-4]. It is unknown, however, whether MA plans lower acute care use relative to Traditional Medicare (TM) or instead shift patients from hospitalizations towards observation stays and emergency department (ED) direct discharges. [...]

Background: Medicare observation stays are increasing nationally. Beneficiaries frequently hospitalized under observation, as well as those needing post-acute care skilled nursing facility coverage, may face increased financial burdens from these services. Patients living in the most disadvantaged neighborhoods have increased risk of inpatient 30-day re-admissions. It is not known whether neighborhood socioeconomic disadvantage increases 30-day [...]

Background: High health care costs and poor outcomes are associated with high hospitalization rates and are concentrated in a small fraction of the population. Fragmented patient care and socioeconomic disadvantage may further increase hospitalization rates. To defragment medical care for a socioeconomically diverse population of Medicare patients at increased risk of hospitalization, the University of [...]

Background: Black seniors have historically had higher readmission rates than white seniors, and hospitals that treat more black seniors have been disproportionately penalized the Medicare Hospital Readmissions Reduction Program (HRRP). Consequently, the policy could exacerbate racial disparities. We sought to determine whether, under the HRRP, trends in 30-day post-discharge mortality differed between black and white [...]

Background: Cost-related medication non-adherence (CRN) is a persistent and serious challenge among the elderly population in the US. For elderly patients with limited economic means at increased risk of hospitalization, CRN may elevate the risk of repeated hospitalizations and emergency department visits, and lead patients into a downward spiral of worse heath and higher non-adherence. [...]

Background: Migraine headache (MHA) is a common pediatric disorder, which frequently leads to hospital admission. Inpatient MHA treatment involves ever-increasingly complex treatment plans, including fluid resuscitation and a variety of medications. Severe Migraine headache may require more aggressive therapy such as dihydroergotamine (DHE) and sphenopalatine ganglion (SPG) block that may prolong hospital stay and increase [...]

Background: The designation of a patient as outpatient versus inpatient status at time of discharge affects how hospitals bill Medicare for services because the center for Medicaid and Medicare services (CMS) reimburses hospitals at a higher rate for inpatient when compared to outpatient designation(1). Since the fiscal year of 2014, one of the major benchmarks [...]