JAMA Internal Medicine: Infectious Respiratory Diseases Topic Collection

Performance and Utilization of an Emergency Department Electronic Screening Tool for Pneumonia

Dean NC, Jones BE, Ferraro JP, et al. — Mon, 22 Apr 2013 00:00:00 GMT

Appropriate treatment of pneumonia begins with accurate diagnosis. However, clinicians have difficulty integrating data for clinical decision making. Significant variability in pneumonia management exists in the emergency department (ED). Decision support might decrease variability and improve care, but physician utilization is historically low. An alerting tool is needed for physicians to utilize computer-based pneumonia decision support.

Computers and the Diagnosis of Pneumonia Comment on“Performance and Utilization of an Emergency Department Electronic Screening Tool for Pneumonia”

Gellad WF, Yealy D, Fine M. — Mon, 22 Apr 2013 00:00:00 GMT

Pneumonia and influenza together ranked as the eighth leading cause of death in the United States and led to over 1 million hospital admissions in 2009, with pneumonia accounting for the majority of the deaths. While most cases will resolve with treatment, patients admitted to the intensive care unit have mortality rates as high as 37%. Prior studies show that timely initiation of appropriate antibiotic therapy is associated with decreased mortality. In addition to its clinical and public health importance, pneumonia is also one of several conditions targeted in “pay for performance” approaches, and hospitals' performance on certain measures of pneumonia quality is publicly reported. Thus, establishing an accurate and timely diagnosis of this illness is imperative.

Complexity Science and the Readmission Dilemma Comment on “Potentially Avoidable 30-Day Hospital Readmissions in Medical Patients” and “Association of Self-reported Hospital Discharge Handoffs With 30-Day Readmissions” Complexity Science and the Readmission Dilemma

Marks E. — Mon, 22 Apr 2013 00:00:00 GMT

The increasing proliferation of articles dealing with hospital readmission is in no small part a response to the recommendations in the 2007 Medicare Payment Advisory Commission report to Congress (http:// www.medpac.gov/documents/Jun07_ EntireReport.pdf). These recommendations became the basis for the Hospital Readmissions Reduction Program in the Affordable Care Act altering the criteria for hospital payment reimbursement. Enforcement of these criteria by the Centers for Medicare & Medicaid Services reduces Medicare payments to hospitals that exceed preset all-cause readmission rates. As health care policy and aspects of care delivery are increasingly influenced by reimbursement, it is important to ensure that the attenuation of the overall health care financial burden is accomplished by research-driven improvements in the quality and safety of care that minimize the potential for unintended outcomes.