1. Nurse home visits after hospitalization for heart failure improve patient outcomes at a reasonable cost
Abstract: http://annals.org/aim/article/doi/10.7326/M19-1980
Editorial: http://annals.org/aim/article/doi/10.7326/M19-3872
URLs go live when the embargo lifts
Compared to usual care, transitional care services, such as nurse home visits, can improve health outcomes and reduce readmissions for a reasonable cost after hospitalization for heart failure. The authors suggest that transitional care services should become the standard of care for post-discharge management of patients with heart failure. Findings from a microsimulation study are published in Annals of Internal Medicine.
Heart failure affects 26 million people globally and is a leading cause of hospitalization and rehospitalization among older adults. Yet despite dozens of studies on methods for reducing rehospitalizations in older patients with heart failure, the great majority of patients still receive usual care, which is careful medication reconciliation, a close outpatient follow-up appointment, and some education. Transitional care service interventions could be a way to reduce rehospitalizations and improve patient outcomes.
Researchers from Stanford University created a microsimulation model using clinical trial, registry, and hospital data to assess the cost-effectiveness of three types of post-discharge heart failure transitional care services and standard care. The interventions assessed included disease management clinics, nurse home visits, and nurse case management, and the patients studied were those with heart failure who were aged 75 at the time of hospital discharge. The researchers found that all three transitional care interventions examined were more costly but also more effective than standard care, with nurse home visits dominating the other two interventions. Compared with standard care, nurse home visits increased quality adjusted life years (QALYs) and costs, resulting in an ICER of $19,570 per QALY gained. Of note according to the researchers, each of the transitional care interventions studied resulted in important improvements in health outcomes, and the differences among them were modest. The authors suggest that it is highly unlikely that standard care post-discharge management is more cost-effective than any of the transitional care services they studied.
An accompanying editorial from New York University School of Medicine and New York University Langone Health says that transitional care services are not standard care yet because initiating them can be complicated and include upfront costs that must be shouldered by health care providers and may not be subsequently reimbursed by payers.
Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Jeremy D. Goldhaber-Fiebert, PhD, please contact Beth Duff-Brown at bethduff@stanford.edu.
2. Doctor on board flight treats unusual case of facial paralysis resembling stroke
Abstract: http://annals.org/aim/article/doi/10.7326/L19-0550
URLs go live when the embargo lifts
Alan J. Hunter from Oregon Health & Science University was a passenger on a recent airline flight when he responded to a flight attendant's request for a "doctor on board." The flight attendant suspected that a young male passenger was having a stroke, which would require an emergency landing. However, upon examination, the physician made an unusual diagnosis. The case report is published in Annals of Internal Medicine.
A medical emergency during a commercial airline flight may require an unplanned landing, which disrupts travel plans and is very costly. Therefore, it is important to know the difference between a true medical emergency and something that does not require an unplanned aircraft landing.
Dr. Hunter found the plane passenger suffering from sudden-onset ear pain, slurred speech, drooling, and complete right-sided facial droop. The man had lost his forehead wrinkles and could not close his right eye, but had no mental symptoms and still had his physical strength. When the man reported that he had recently recovered from a cold and that his symptoms began during ascent, Dr. Hunter determined that there was no reason to deter the plane. The man's symptoms were caused by declining atmospheric pressure in the cabin causing a relative increase in middle ear pressure from a blocked Eustachian tube that was transmitted to the branches of the seventh nerve as they ran through his middle ear. According to Dr. Hunter, this condition is described as facial barotrauma. It occurs during ascent in scuba divers and infrequently while flying, during land travel at high altitudes, after certain operations on the middle ear, and with some structural disorders of the middle ear. The paralysis usually resolves within 15 to 30 minutes after maneuvers to reduce middle ear pressure, such as yawning, swallowing with pinched nostrils, and the Valsalva maneuver. Breathing oxygen-enriched air improves tissue oxygenation, which also helps.
Media contacts: For an embargoed PDF or contact information for Alan J. Hunter, MD, please contact Lauren Evans at laevans@acponline.org.
Also new in this issue:
Revisiting the National Institutes of Health Fair Pricing Condition: Promoting the Affordability of Drugs Developed With Government Support
Heather M. Gilmartin, PhD, NP; Vincent X. Liu, MD, MSc; Robert Ameet Sarpatwari, PhD, JD; Alison K. LaPidus, MPH; and Aaron S. Kesselheim, MD, JD, MPH
Ideas and Opinions
Abstract: http://annals.org/aim/article/doi/10.7326/M19-2576
Who Owns Sepsis?
Michael Klompas, MD, MPH; Tiffany M. Osborn, MD, MPH; and Chanu Rhee, MD, MPH
Ideas and Opinions
Abstract: http://annals.org/aim/article/doi/10.7326/M19-2966
Dietary Assessment and Opportunities to Enhance Nutritional Epidemiology Evidence
Ross L. Prentice, PhD
Ideas and Opinions
Abstract: http://annals.org/aim/article/doi/10.7326/M19-3290
A Disclosure Form for Work Submitted to Medical Journals: A Proposal From the International Committee of Medical Journal Editors
Darren B. Taichman, MD, PhD
Editorial
Abstract: http://annals.org/aim/article/doi/10.7326/M19-3933
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Journal
Annals of Internal Medicine