A shorter screening tool might encourage more providers to add depression screening to routine health care visits. The GDS-5/15 is an alternative screening tool.
Key PointsQuestionWere there changes in the rates of in-hospital adverse events between 2010 and 2019?FindingsIn this serial cross-sectional study of 244 542 adult patients hospitalized in 3156 US hospitals from 2010 to 2019, there were statistically significant decreases in the annual rates of in-hospital adverse events for admissions for acute myocardial infarction (annual adjusted relative risk [RR], 0.94), heart failure (RR, 0.95), pneumonia (RR, 0.94), major surgical procedures (RR, 0.93), and all other conditions (RR, 0.97).MeaningThe rates of adverse events in hospitalized patients significantly declined for patients with acute myocardial infarction, heart failure, pneumonia, and major surgical procedures between 2010 and 2019 and significantly declined for patients with all other conditions between 2012 and 2019.
On June 1, 2021, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr).End-stage renal disease (ESRD) is a condition in which kidney function has permanently declined such that renal replacement therapy* is required to sustain life (1). The mortality rate for patients with ESRD in the United States has been declining since 2001 (2). However, during the COVID-19 pandemic, ESRD patients are at high risk for COVID-19-associated morbidity and mortality, which is due, in part, to weakened immune systems and presence of multiple comorbidities (3-5). The ESRD National Coordinating Center (ESRD NCC) supports the Centers for Medicare & Medicaid Services (CMS) and the ESRD Networks †, § through analysis of data, dissemination of best practices, and creation of educational materials. ESRD NCC analyzed deaths reported to the Consolidated Renal Operations in a Web-Enabled Network (CROWNWeb), a system that facilitates the collection of data and maintenance of information about ESRD patients on chronic dialysis or receiving a kidney transplant who are treated in Medicare-certified dialysis facilities and kidney transplant centers in the United States. Excess death estimates were obtained by comparing observed and predicted * Renal replacement therapy is the broad name for any of the treatment choices available when kidney function has declined below an estimated glomerular filtration rate (eGFR) of 15 mL/min/1.73 m 2 . These therapies include conservative management, peritoneal dialysis, hemodialysis, and transplant.
The National Nursing Home Improvement Collaborative aimed to reduce pressure ulcer (PU) incidence and prevalence. Guided by subject matter and process experts, 29 quality improvement organizations and six multistate long-term care corporations recruited 52 nursing homes in 39 states to implement recommended practices using quality improvement methods. Facilities monitored monthly PU incidence and prevalence, healing, and adoption of key care processes. In residents at 35 regularly reporting facilities, the total number of new nosocomial Stage III to IV PUs declined 69%. The facility median incidence of Stage III to IV lesions declined from 0.3 per 100 occupied beds per month to 0.0 (P<.001) and the incidence of Stage II to IV lesions declined from 3.2 to 2.3 per 100 occupied beds per month (P=.03). Prevalence of Stage III to IV lesions trended down (from 1.3 to 1.1 residents affected per 100 occupied beds (P=.12). The incidence and prevalence of Stage II lesions and the healing time of Stage II to IV lesions remained unchanged. Improvement teams reported that Stage II lesions usually healed quickly and that new PUs corresponded with hospital transfer, admission, scars, obesity, and immobility and with noncompliant, younger, or newly declining residents. The publicly reported quality measure, prevalence of Stage I to IV lesions, did not improve. Participants documented disseminating methods and tools to more than 5,359 contacts in other facilities. Results suggest that facilities can reduce incidence of Stage III to IV lesions, that the incidence of Stage II lesions may not correlate with the incidence of Stage III to IV lesions, and that the publicly reported quality measure is insensitive to substantial improvement. The project demonstrated multiple opportunities in collaborative quality improvement, including improving the measurement of quality and identifying research priorities, as well as improving care.
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