David H. Wesorick, MD; Vineet Chopra, MD, MSc
Disclosures: Dr. Chopra reports grants from the Agency for Healthcare Research and Quality. Dr. Wesorick has disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1400.
The authors conclude that readmissions occurring within 7 days of discharge are more likely to be attributable to care provided in the hospital than readmissions occurring from 8 to 30 days, which appear more attributable to outpatient care.
The authors suggest that a 7-day readmission cutoff might be a more reasonable accountability measure for hospitals than the established 30-day cutoff. However, they also acknowledge that no cutoff will perfectly distinguish the accountability for readmissions between inpatient and outpatient care. Instead, they call for a better model of collaboration between inpatient and outpatient providers and shared accountability for readmissions.
This study shows that it is possible to utilize information about opioid prescribing patterns (e.g., information from prescription drug monitoring programs [PDMPs]) to identify patients who are at high risk for opioid-related complications.
Almost all of the studied misuse patterns (even ones that might be beneath the conventional thresholds for suspicious use) were associated with an increased risk for opioid overdose.
An accompanying editorial notes that current PDMPs are limited by a lack of standardization and a failure to present complex data in a way that is useful to clinicians (i.e., in a way that allows clinicians to easily recognize the high-risk patterns). The authors suggest that approaches aimed at these factors may lead to improvements in PDMPs and better stewardship of these medications.
Circulating Aβ40 seems to accurately predict mortality in patients presenting with NSTE-ACS, and the clinical use of this test may ultimately allow for improved risk stratification of these patients.
The authors note that, although this test may not yet be ready for clinical application, prospective studies evaluating the use of this biomarker in patients with NSTE-ACS seem necessary.
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Wesorick DH, Chopra V. Annals for Hospitalists - 19 June 2018. Ann Intern Med. ;168:HO1. doi: 10.7326/AFHO201806190
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Published: Ann Intern Med. 2018;168(12):HO1.
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