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.
This study shows that the preoperative NT-proBNP level is helpful in assigning risk for vascular death and MINS in noncardiac surgical patients, and that the information derived from measuring NT-proBNP levels improves preoperative risk stratification when added to the RCRI.
Editorialists conclude that NT-proBNP improves the accuracy of preoperative risk stratification but also suggest that more research is needed to determine whether an NT-proBNP–driven perioperative management strategy will actually improve outcomes for patients.
This new risk model may more accurately predict 6-month post-MI mortality for patients aged 75 years or older.
Use of the model might allow for more accurate identification of high-risk, older patients who may benefit from more aggressive secondary prevention measures, closer follow-up, and even palliative approaches to care.
Editorialists note that additional research is needed to externally validate the model and to develop and deploy interventions to improve outcomes for the highest-risk patients.
In this study of highly selected patients, hospital-level care at home (vs. traditional hospital admission) resulted in lower costs, less health care use, and lower hospital readmission rates while preserving quality, safety, and patient satisfaction.
The home care provided in this study employed several sophisticated elements, including continuous monitoring of patients' vital signs and activity; 24-hour access to video and texting; 24-hour physician coverage; and virtual subspecialist consultation, when needed.
Editorialists point out that there is now substantial evidence that hospital-level care at home for selected patients can reduce overall costs while meeting quality standards. However, they also acknowledge the barriers to implementing this type of program, including massive clinical, administrative, and infrastructural demands of providing this level of care in the home and the lack of an established payment model.
The 3WP seems to be a low-cost end-of-life intervention that effectively shifts the focus away from the patient's terminal illness and toward their identity and preferences, enhancing the experience of care for the family, and making work more meaningful for the involved clinicians.
The authors suggest that the program is feasible, portable, and scalable and that it can be adapted to suit the interests, resources, and needs of a variety of units.
Wesorick DH, Chopra V. Annals for Hospitalists - 21 January 2020. Ann Intern Med. 2020;172:HO1. doi: https://doi.org/10.7326/AWHO202001210
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Published: Ann Intern Med. 2020;172(2):HO1.
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