Large Increases in Spending on Postacute Care in Medicare Point to the Potential for Cost Savings in These Settings.
Large increases in spending on postacute care in medicare point to the potential for cost savings in these settings.
Health Aff (Millwood). 2013 May; 32(5): 864-72
Chandra A, Dalton MA, Holmes J
Identifying policies that will cut or constrain US health care spending and spending growth dominates reform efforts, yet little is known about whether the drivers of spending levels and of spending growth are the same. Policies that produce a one-time reduction in the level of spending, for example by making hospitals more efficient, may do little to reduce subsequent annual spending growth. To identify factors causing health care spending to grow the fastest, we focused on three conditions in the Medicare population: heart attacks, congestive heart failure, and hip fractures. We found that spending on postacute care-long-term hospital care, rehabilitation care, and skilled nursing facility care-was the fastest growing major spending category and accounted for a large portion of spending growth in 1994-2009. During that period average spending for postacute care doubled for patients with hip fractures, more than doubled for those with congestive heart failure, and more than tripled for those with heart attacks. We conclude that policies aimed at controlling acute care spending, such as bundled payments for short-term hospital spending and physician services, are likely to be more effective if they include postacute care, as is currently being tested under Medicare’s Bundled Payment for Care Improvement Initiative. HubMed – rehab
How could right ventricular outflow tract stenting be made into one of the many small steps on the long road to solid evidence of rehabilitation of pulmonary arteries?
Eur J Cardiothorac Surg. 2013 May 5;
Bogers AJ, van de Woestijne PC
Surgery following primary right ventricular outflow tract stenting for Fallot’s Tetralogy and variants: rehabilitation of small pulmonary arteries.
Eur J Cardiothorac Surg. 2013 May 5;
Barron DJ, Ramchandani B, Murala J, Stumper O, De Giovanni JV, Jones TJ, Stickley J, Brawn WJ
OBJECTIVES: Primary surgical repair of Tetralogy of Fallot (ToF) in small infants with small pulmonary arteries (PAs) or complex anatomies can be hazardous. We assessed the effect of right ventricular outflow tract (RVOT) stenting on subsequent surgical intervention with attention to growth of the PAs. METHODS: Primary RVOT stenting was performed in 32 symptomatic patients with ToF physiology. Twenty patients had surgical intervention, with 15 undergoing complete repair to date. Median age at stenting was 61 (range 8-406) days, and median weight, 3.9 (range 1.8-12.2) kg. RESULTS: Stenting improved saturations from 72 ± 8 to 92 ± 2% (P < 0.001). Four patients required early surgical palliation for persistent desaturation (within 4 weeks). Twenty patients went on to have surgical intervention at a median time of 220 days after stenting. There was no operative mortality after complete repair. Removing the stent lengthened the procedure time and 86% required transannular patch (TAP; bypass time 109 ± 42 min, cross clamp 68 ± 29 min). Median intensive therapy unit stay was 2 days. There was 1 late death at 3 months due to chronic lung disease. The median left PA Z-score increased from a preinterventional value of -1.27 (-0.19 to -2.87) to a presurgical value of +0.11 (-4.12 to +1.97). The median right PA Z-score increased from -2.02 (-1.77 to -4.68) to -0.65 (-0.29 to -2.04) over the preinterventional and presurgical time intervals. Growth was greatest in the right PA. CONCLUSIONS: Primary RVOT stenting facilitates staged palliation for ToF in small infants and complex anatomies. Improved PA blood flow generated by the stent leads to growth of the branch PAs and may improve the substrate for subsequent surgical repair. Surgery is safe; however, the majority will require a TAP. HubMed – rehab
Reconstruction of intracranial vertebral artery with radial artery and occipital artery grafts for fusiform intracranial vertebral aneurysm not amenable to endovascular treatment: technical note.
Acta Neurochir (Wien). 2013 May 7;
Kubota H, Tanikawa R, Katsuno M, Noda K, Ota N, Miyata S, Yabuuchi T, Izumi N, Bulsara KR, Hashimoto M
BACKGROUND: Symptomatic fusiform intracranial vertebral artery aneurysms pose a formidable treatment challenge when not amenable to endovascular treatment. In this paper, we illustrate the microsurgical management of such an aneurysm. METHODS: To prevent neurological deterioration, anatomical reconstruction preserving all vessels including posterior inferior cerebellar artery and perforators is essential. In this case illustration, the occipital artery was used as a donor to a perforator originating from the aneurysmal segment. This bypass was performed in an end-to-side fashion. Subsequently, the aneurysmal component of the vertebral artery was resected and an end-to-side (V4 to V3) bypass was performed using a radial artery graft. RESULTS: The patient achieved complete resection of the aneurysm preserving normal anatomy of the posterior circulation without any ischemic complications. CONCLUSIONS: Complex cerebral artery bypass techniques are essential in the armamentarium of cerebrovascular for the treatment of complex lesions not amenable to endovascular therapy. HubMed – rehab
Stroke Rehabilitation: Issues for Physiotherapy and Physiotherapy Research to Improve Life after Stroke.
Physiother Res Int. 2013 May 6;
Langhammer B, Verheyden G