Potentially avoidable hospitalizations are common and costly in the dually eligible population. New initiatives are needed to reduce PAH in this population as they are costly and can adversely affect function and quality of life.

Little national data have been available to guide the design of programs aimed at reducing the hospitalization of nursing home residents. This article uses the 1987 National Medical Expenditure Survey to identify elderly nursing home residents with an elevated risk of hospitalization and the reasons for and outcomes of residents' hospital stays. Study findings include an elevated risk of hospitalization for residents with one of several different primary diagnoses and a rise in risk as ADL dependence increases. An infection was the main medical reason for roughly 27% of hospital stays. The results suggest possible target groups for two types of programs aimed at reducing hospitalization.

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Introduction Pulmonary nodules are detected in over a million Americans each year. Prior qualitative work suggests the detection of incidental pulmonary nodules can be burdensome for patients, but it is unknown whether these findings generalize to a broader sample of patients. We categorized patients’ knowledge, beliefs, and distress associated with detection and evaluation of a pulmonary nodule, and their impressions of clinician communication. Methods We administered a cross-sectional survey to adults with an incidental pulmonary nodule recruited from a rural medical center, an urban safety net hospital, and a Veterans Affairs hospital. Results Of 490 surveys mailed, 244 (50%) responded. Median nodule size was 7 mm; mean patient age was 67 years; 29% were female, and 86% were white. A quarter (26%) of respondents reported clinically significant distress related to their nodule as measured by the Impact of Event scale, our primary outcome. Patients reported multiple concerns including uncertainty about the nodule’s etiology (78%), the possibility of cancer (73%), and the possible need for surgery (64%). Only 25% of patients accurately estimated their lung cancer risk (within 15% of their actual risk); overall there was no correlation between perceived and actual risk (r=−0.007, p=0.93). Among the 23% of patients who did receive cancer risk information from their provider, they were more likely to find this information reassuring (16%) than scary (7%). Conclusion A quarter of patients with incidental pulmonary nodules experienced clinically significant distress. Knowledge about cancer risk and evaluation was poor. Clinician communication may help bridge knowledge gaps and alleviate distress in some patients.