Background Recent efforts to improve care for patients hospitalized with heart failure have focused on process-based performance measures. Data supporting the link between current process measures and patient outcomes are sparse. Objective To examine the relationship between adherence to hospital-level process measures and long-term patient-level mortality and readmission. Research Design Analysis of data from a national clinical registry linked to outcome data from the Centers for Medicare & Medicaid Services (CMS). Subjects 22750 Medicare fee-for-service beneficiaries enrolled in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) between March 2003 and December 2004. Measures Mortality at 1 year; cardiovascular readmission at 1 year; and adherence to hospital-level process measures, including discharge instructions, assessment of left ventricular function, prescription of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker at discharge, prescription of beta-blockers at discharge, and smoking cessation counseling for eligible patients. Results Hospital conformity rates ranged from 52% to 86% across the 5 process measures. Unadjusted overall 1-year mortality and cardiovascular readmission rates were 33% and 40%, respectively. In covariate-adjusted analyses, the CMS composite score was not associated with 1-year mortality (hazard ratio, 1.00; 95% confidence interval, 0.98-1.03; P = .91) or readmission (hazard ratio, 1.01; 95% confidence interval, 0.99-1.04; P = .37). Current CMS process measures were not independently associated with mortality, though prescription of beta-blockers at discharge was independently associated with lower mortality (hazard ratio, 0.94; 95% confidence interval, 0.90-098; P = .004). Conclusion Hospital process performance for heart failure as judged by current CMS measures is not associated with patient outcomes within 1 year of discharge, calling into question whether existing CMS metrics can accurately discriminate hospital quality of care for heart failure.

Among Medicare beneficiaries, TRI with SDD was independently associated with fewer complications and lower in-hospital costs. These findings have important implications for changing the current PCI care pathways to improve outcomes and reduce costs.

Elderly reporting psychologic distress were less likely to adhere to some, but not all, recommended preventive care guidelines. These results suggest that adherence to recommended preventive care guidelines may be improved, indirectly, by improving recognition and treatment of emotional health problems in the elderly.

BACKGROUND Hospital Onset Clostridioides difficile infection (HO-CDI) is a costly problem leading to readmissions, morbidity and mortality. We evaluated the effect of a single probiotic strain, Saccharomyces boulardii, at a standardized dose on the risk of HO-CDI within hospitalized patients administered antibiotics frequently associated with HO-CDI. METHODS This retrospective cohort study merged hospital prescribing data with HO-CDI case data. The study assessed patients hospitalized from January 2016 through March 2017 that were administered at least one dose of an antibiotic frequently associated with HO-CDI during hospitalization. Associations between S. boulardii administration, including timing, and HO-CDI incidence were evaluated by multivariable logistic regression. RESULTS The study included 8,763 patients. HO-CDI incidence was 0.66% in the overall cohort. HO-CDI incidence was 0.56% and 0.82% among patients co-administered S. boulardii with antibiotics and not co-administered S. boulardii, respectively. In adjusted analysis, patients co-administered S. boulardii had a reduced risk of HO-CDI (OR=0.57, 95% CI 0.33–0.96, p=0.04) compared to patients not co-administered S. boulardii. Patients co-administered S. boulardii within 24-hours of antibiotic start demonstrated a reduced risk of HO-CDI (OR=0.47, 95% CI 0.23–0.97, p=0.04) compared to those co-administered S. boulardii after 24-hours of antibiotic start. CONCLUSIONS S. boulardii administered to hospitalized patients prescribed antibiotics frequently linked with HO-CDI was associated with a reduced risk of HO-CDI.

No abstract