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Diminishing Patient Face Time in Residencies and Patient-Centered Care

One of the more important recommendations coming from the Institute of Medicine’s seminal report on medical errors was the pressing need to implement patient-centered medical care. Although emphatically endorsed and highly influential, adoption of its 6 dimensions in “real life” has been slow, uncommon, and imperfect in most settings studied. Considering how residents spend their […]

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Improving Warfarin Management Within the Medical Home: A Health-System Approach

Anticoagulation clinics have been considered the optimal strategy for warfarin management with demonstrated improved patient outcomes through increased time in therapeutic international normalized ratio (INR) range, decreased critical INR values, and decreased anticoagulation-related adverse events. However, not all health systems are able to support a specialized anticoagulation clinic or may see patient volume exceed available […]

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Best Practice Advisories Should Not Replace Good Clinical Acumen

Electronic medical records (EMR) have revolutionized clinical practice. They facilitate documentation, improve communication and coordination of care among medical providers, and afford a manner of communication for patients, as well as provide a platform for the storage of large quantities of clinical data. Several of these qualities, in addition to federal incentives for their use, […]

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30-Day Readmissions After an Acute Kidney Injury Hospitalization

The risk of hospital readmission in acute kidney injury survivors is not well understood. We estimated the proportion of acute kidney injury patients who were rehospitalized within 30 days and identified characteristics associated with hospital readmission. Methods We conducted a population-based study of patients who survived a hospitalization complicated by acute kidney injury from 2003-2013 […]

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Dr. Joseph S. Alpert

The Readmission Problem: A Modest Proposal Seeking a Solution

It is certainly no secret that patient readmissions shortly after discharge from the hospital create major healthcare and social problems today in the United States and throughout the world.1, 2, 3, 4, 5, 6, 7, 8, 9 Given our ever increasing number of elderly, frail patients in the United States, it is not surprising that many of these individuals are readmitted soon after discharge. […]

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