ALLERGY, RESPIRATORY
'Safe' Ozone Levels May Not Be for Some
Know Your Asthma Triggers
Overweight Moms More Likely to Have Asthmatic Kids
ALTERNATIVE MEDICINE
Animals Respond to Acupuncture's Healing Touch
Awareness of Alternative Therapies May Be Lacking
Relaxation Tapes or Mozart Lower Blood Pressure
ANIMAL CARE
Animals Respond to Acupuncture's Healing Touch
Safe Toys for Dogs
Beware of Dog Bites
BONES & JOINTS
Occupational Therapy Plus Exercise Benefits Osteoarthritis
B Cells Can Act Alone in Autoimmune Diseases
Returning to the Road Tricky After Injury
CANCER
Poor Women Seem to Be Skipping Breast Cancer Drugs
Broccoli May Help Battle Breast Cancer
Many Cancer Survivors Don't Adopt Healthy Lifestyle
CAREGIVING
Exercise During Pregnancy May Help Baby
Health Tip: Benefitting From Adult Day Care
Undoing the 'Big Baby' Trend
CIRCULATORY SYSTEM
Bye, Bye Back Fat?
Anemia Rates Down for U.S. Women and Children
Firefighters Have Narrower-Than-Normal Arteries, Study Finds
COSMETIC
Study Evaluates Laser Therapies for Hair Removal
Get Sugared!.... Its a sweet choice for hair removal
Mouse Study Finds Molecule That Tells Hair to Grow
DENTAL, ORAL
A Sweet Way to Shield Baby's Teeth
Gum Disease Treatment Doesn't Cut Preterm Birth Risk
Gum Disease Might Boost Cancer Risk
DIABETES
Whole Grains Take a Bite Out of Type 2 Diabetes Risk
Abnormal Heart Rhythm Boosts Death Risk for Diabetics
Exercise Protects Black Women From Type 2 Diabetes
DIET, NUTRITION
5 Reasons why you could gain weight while dieting
Cinnamon Breaks Up Brain Plaques, May Hold Key to Fighting Alzheimer’s
Oregano Shown to be the Most Powerful Culinary Herb
DISABILITIES
Review Finds Marijuana May Help MS Patients
Could Your Cell Phone Help Shield You From Alzheimer's?
ENVIRONMENTAL HEALTH
Think You Are Lead-Free? Check Your Soil
Plastics Chemical Tied to Aggression in Young Girls
Where You Live May Affect Your Cancer Diagnosis
EYE CARE, VISION
Glaucoma Associated With Reading Impairments in Elderly
Eye Disease, Cognitive Decline Linked in Study
Nearly 18 Million Will Have Macular Degeneration by 2050
FITNESS
Walk Long, Slow and Often to Help the Heart
Daily Exercise at School Yields Rewards
Exercise Extends Life of Kidney Patients
GASTROINTESTINAL PROBLEMS
Peppermint Oil, Fiber Can Fight Irritable Bowel
Bowel Prep Harder on Women Than Men
New Guidelines Issued for Management of IBS
GENERAL HEALTH
Heal Your Life® Tips for Living Well
Swine Flu Loves a Crowd
Kids With Vitamin D Deficiency Linked to Heart Trouble
HEAD & NECK
Ski Helmets Encouraged for All
Zen May Thicken Brain, Thwart Pain
Many Children Will Outgrow Headaches
HEALTH & TECHNOLOGY
Airport Full Body Scanners Pose No Health Threat: Experts
The Internet Is Becoming One-Stop Shopping for Health Help
Imaging Sheds Light on How Acupuncture Works
HEARING
Noise Hurts Men's Hearing More, Study Shows
Summer Sounds Can Lead to Hearing Loss
HEART & CARDIOVASCULAR
Fondness for Fish Keeps Japanese Hearts Healthy
Research Shows Genetic Activity of Antioxidants
Kids With Vitamin D Deficiency Linked to Heart Trouble
INFECTIOUS DISEASE
Dry Weather Boosts Odds of Flu Outbreaks
Bacterial Infections May Succumb to Honey
Viral Infection Might Trigger High Blood Pressure
INFERTILITY
Obesity May Affect Fertility in Young Womene
KID'S HEALTH
Childhood Dairy Intake Boosts Bone Health Later On
Heart Defects in Newborns Linked to Antidepressants
Babies Cared For In Others Homes Might Become Heavy Toddlers
MEN'S HEALTH
Low Iron Levels Cut Cancer Risk in Men With PAD
Could Chinese Herb Be a Natural Viagra?
Drinking Green Tea May Slow Prostate Cancer
MENTAL HEALTH
Most Depressed Teens Don't Get Treatment
Meditation, Yoga Might Switch Off Stress Genes
Cinnamon Breaks Up Brain Plaques, May Hold Key to Fighting Alzheimer’s
PAIN
Are We Exercising Pain Away? Not So Much.
Alleviating Rheumatoid Arthritis
Acupuncture, Real or Fake, Eases Back Pain
PHYSICAL THERAPY
PREGNANCY
Sugary Colas Tied to Gestational Diabetes
Acupuncture May Relieve Acid Indigestation In Pregnancy
Exercise Boosts Bone Density in Breast-Feeding Moms
SENIORS
Tai Chi May Help Ward Off Knee Pain in Seniors
Older People at Greater Risk of Swine Flu Death
Video Gaming Just Might Fight Aging
SEXUAL HEALTH
SLEEP DISORDERS
Lose Weight, Sleep Apnea May Improve
Exercising Throat Muscles May Relieve Sleep Apnea
Moderate Aerobics May Ease Insomnia Symptoms
WOMEN'S HEALTH
Acupuncture May Relieve Acid Indigestation In Pregnancy
Steady Weight Gain Boosts Late-Life Breast Cancer Risk
Health Tip: Be More Comfortable During Childbirth
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High Rate of Rehospitalizations Costing Billions

WEDNESDAY, April 1 (HealthDay News) -- One in five Medicare patients discharged from the hospital is readmitted within 30 days, while half end up back in the hospital within a year, a new study finds.

The groundbreaking research exposes a "frequent, costly and sometimes life-threatening" problem that researchers believe could be prevented through better care coordination. The study appears in the April 2 issue of the New England Journal of Medicine.

The message here for Medicare patients and their families: Be your own advocate to avoid landing back in the hospital.

"The things that may not feel right to you about the discharge process may not be right, and you should be prepared to stand up for what you need," said study author Dr. Stephen F. Jencks, former director of the Quality Improvement Group at the Centers for Medicare and Medicaid Services in Baltimore.

Not only do Medicare patients need to know how to care for themselves at home and who to call if they have a problem, they also need to make sure a follow-up appointment is scheduled with a physician before leaving the hospital, Jencks said.

In 2004, unplanned rehospitalizations cost Medicare an estimated $17.4 billion, the study authors noted.

President Barack Obama's 2009 budget proposal targets the problem through a combination of financial incentives and penalties. He would pay hospitals a "bundled" rate that includes inpatient care as well as certain post-acute care services provided 30 days after hospitalization. Hospitals with high readmission rates would be paid less if patients are readmitted to the hospital within the same 30-day period.

To date, most studies examining rehospitalization have focused on specific diseases, such as heart failure or chronic obstructive pulmonary disease.

"I think one of the strengths of the Jencks analysis is that he looks at all-cause rehospitalizations, and that's a unique and a new view," said Dr. Amy Boutwell, a general internist at Newton-Wellesley Hospital in Newton, Mass., and director of the Institute for Healthcare Improvement's reducing rehospitalizations initiative.

For the study, researchers analyzed Medicare claims data from October 2003 through December 2004. The study included information on almost 12 million patients discharged from a hospital during that time.

Overall, the data showed that the risk of rehospitalization persists over time. About two in every three Medicare beneficiaries (62.9 percent) discharged from the hospital were readmitted or died within a year.

The study also revealed wide geographic disparities in rates of rehospitalization within 30 days of discharge -- from a low of 13.3 percent in Idaho to a high of 23.2 percent in Washington, D.C.

Often, the people who cycle in and out of the hospital suffer from multiple medical conditions or psychiatric or social problems, Boutwell said. Someone who relies on an intricate caregiving network -- say, their daughter-in-law, their neighbor and a church member -- can get into trouble when that social safety net breaks down, she explained.

"We have a short-hand nickname for them. We call them 'bounce-backs' or frequent fliers," Boutwell said. "And although that's not a very sensitive term, I think it reflects the fact that throughout the medical profession we implicitly recognize that there is this group of patients who are in and out of the hospital with quite high frequency."

But it's not just about being sick and ending up back in the hospital. "It's about traversing from one setting of care to the next setting of care successfully and stably," said Boutwell, who is leading a multi-state initiative to reduce avoidable rehospitalizations.

The fundamental barrier to better care, said Jencks, is a health system built around what he called "silos" -- the hospital, the doctor's office, the nursing home -- resulting in poor transitions from one care setting to another.

In an accompanying editorial, Dr. Arnold M. Epstein of the Harvard School of Public Health in Boston, said that "providing appropriate incentives for hospitals and community providers to share accountability and provide efficient care will be no easy task."

But Jencks suggested that immediate action is imperative. "The evidence is that the system is not working right and it's costing us billions of dollars a year and it's causing a great deal of patient and family misery," he said, "and we need to get cracking on it."

-Karen Pallarito

More information

Medicare has a checklist of questions that patients and caregivers should ask before leaving the hospital.



SOURCES: Stephen F. Jencks, M.D., M.P.H., independent consultant, Baltimore; Amy Boutwell, M.D., M.P.P., general internist, Newton-Wellesley Hospital, Newton, Mass., content director, Institute for Healthcare Improvement, and director, IHI's reducing rehospitalizations initiative, Cambridge, Mass.; Budget of the United States Government, Fiscal Year 2010, Office of Management and Budget, Washington, D.C.; April 2, 2009, New England Journal of Medicine

Last Updated: April 01, 2009

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