ALLERGY, RESPIRATORY
Folic Acid Might Offer Allergy Relief
Combating Myths About Seasonal Allergies
Air Pollution May Raise Blood Pressure
ALTERNATIVE MEDICINE
Awareness of Alternative Therapies May Be Lacking
Alternative Treatments May Boost IVF Success
Massage Fosters Healing in Bereaved Relatives
ANIMAL CARE
Animals Respond to Acupuncture's Healing Touch
Safe Toys for Dogs
Separation Anxiety, Canine-Style
BONES & JOINTS
Improved Hip Implants Can Last 20 Years
Arthritis Hits More Than Half of Diabetics
Low Vitamin D Raises Women's Hip Fracture Risk
CANCER
Strenuous Daily Workout May Keep Cancer at Bay
Method for Treating Cervical Lesions May Pose Pregnancy Risks
Asthmatics Who Quit Smoking May Reverse Lung Damage
CAREGIVING
New Guidelines for Treating Heart Failure
MRSA Infections Spreading to Kids in Community
Hospital Practices Influence Which Moms Will Breast-Feed
CIRCULATORY SYSTEM
Mercury in Fish Linked to High Blood Pressure
Anemia Rates Down for U.S. Women and Children
Drink a Little Wine, Live a Little Longer
COSMETIC
With Psoriasis, the Internet May Offer Hope
What to Do If You Have Unsightly Veins
Study Evaluates Laser Therapies for Hair Removal
DENTAL, ORAL
Gum Disease Treatment Doesn't Cut Preterm Birth Risk
Gummy Bears Join Cavity Fight
Acid Drinks Blamed for Increase in Tooth Erosion
DIABETES
Red-Grape Compound May Improve Diabetes
Boosting Vitamin D Can Do a Heart Good
Findings Challenge Tight Glucose Control for Critically Ill Patients
DIET, NUTRITION
Vitamin D May Help Keep Aging at Bay
Trans-Fat Ban In New York City Is Proving successful
Oregano Shown to be the Most Powerful Culinary Herb
DISABILITIES
Could Your Cell Phone Help Shield You From Alzheimer's?
Review Finds Marijuana May Help MS Patients
ENVIRONMENTAL HEALTH
Fish in U.S. Rivers Tainted With Common Medications
Chemical in Plastics May Cause Fertility Problems
Air Pollution Exposure May Slow Fetal Growth
EYE CARE, VISION
Florida Vision Test Law: Fewer Traffic Deaths Among Elderly
When Gauging Age, the Eyes Have It
Protein Might One Day Prevent Blindness
FITNESS
Barefoot Best for Running?
Many Cancer Survivors Don't Adopt Healthy Lifestyle
Mom and Baby Alike May Benefit From Exercise
GASTROINTESTINAL PROBLEMS
Olive Oil May Protect Against Bowel Disease
Soothing Imagery May Help Rid Some Kids of Stomach Pain
Traditional Nonsurgical GERD Treatments Not Impressive
GENERAL HEALTH
To Quit Smoking, Try Logging On
Eat Light - Live Longer
Poor Restroom Cleaning Causes Cruise-Ship Sickness
HEAD & NECK
Zen May Thicken Brain, Thwart Pain
Many Children Will Outgrow Headaches
Ski Helmets Encouraged for All
HEALTH & TECHNOLOGY
Study Suggests Link Between Cell Phones and Brain Tumors
Subway Defibrillators Save Lives
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
Western Diet Linked To Heart Disease, Metabolic Syndrome
Psychiatric Drugs Might Raise Cardiac Death Risk
Potassium-Rich Foods May Cut Stroke, Heart Disease Risk
INFECTIOUS DISEASE
More Medicinal Uses for Pomegranate
Surgical Masks Could Prevent Flu, Maybe
Poor Restroom Cleaning Causes Cruise-Ship Sickness
INFERTILITY
Obesity May Affect Fertility in Young Womene
KID'S HEALTH
Babies Cared For In Others Homes Might Become Heavy Toddlers
Traffic Seems to Make Kids' Asthma Worse
School Phys. Ed. Injuries Up 150 Percent
MEN'S HEALTH
Could Chinese Herb Be a Natural Viagra?
Low Vitamin D Levels May Boost Men's Heart Attack Risk
Noise Hurts Men's Hearing More, Study Shows
MENTAL HEALTH
The Acne Drug Accutane More Than Doubles Depression Risk
The 3LS Wellness Program for Reversing Chronic Symptoms and Creating Lasting Health
Estrogen May Help Men's Hearts
PAIN
'Cell Phone Elbow' -- A New Ill for the Wired Age
Are We Exercising Pain Away? Not So Much.
Acupuncture, Real or Fake, Eases Back Pain
PHYSICAL THERAPY
PREGNANCY
Woman in America Are Delaying Motherhood, Study Says
Acupuncture May Ease Depression During Pregnancy
Exercise As Well As Acupuncture, May Ease Polycystic Ovarian Syndrome
SENIORS
Tai Chi and Qigong Offer Many Health Benefits: Review
Seniors Who Volunteer May Live Longer
For Older Walkers, Faster Is Better
SEXUAL HEALTH
SLEEP DISORDERS
Moderate Aerobics May Ease Insomnia Symptoms
Meditation May Help Put Primary Insomnia to Bed
Exercising Throat Muscles May Relieve Sleep Apnea
WOMEN'S HEALTH
Natural Therapies for Menopause
Exercise, Weight Control May Keep Fibromyalgia at Bay
Most Women With Osteoporosis Unaware of Raised Fracture Risk
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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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