Publications by authors named "Shoshana J Herzig"
Background: Timely follow-up after cardiovascular hospitalization is recommended to monitor recovery, titrate medications, and coordinate care.
Objective: To describe trends and disparities in follow-up after acute myocardial infarction (AMI) and heart failure (HF) hospitalizations.
Design: Retrospective cohort study.
Importance: In 2013, Medicare implemented payments for transitional care management (TCM) services, which provide increased reimbursement to clinicians providing ambulatory care to patients after discharge from medical facilities to the community.
Objective: To determine whether the introduction of TCM payments was associated with an increase in timely postdischarge follow-up.
Design, Setting, And Participants: This cross-sectional interrupted time-series study assessed quarterly postdischarge visit rates before (2010-2012) and after (2013-2019) TCM implementation 100% sample of Medicare fee-for-service beneficiaries discharged to the community after a hospital or skilled nursing facility stay.
Article Synopsis
- Hospitalized patients often have higher blood pressure (BP) than recommended, and there is no consistent standard for managing elevated BP during hospitalization.
- A systematic review identified 14 clinical practice guidelines on BP management, of which 11 were deemed high-quality, yet many lacked clear guidelines for inpatient BP targets or managing moderately elevated BP without symptoms.
- Hypertensive emergencies typically require immediate intravenous antihypertensives, while the management of hypertensive urgencies is inconsistent and mostly focused on emergency department protocols.*
Article Synopsis
- * This study aimed to assess the impact of starting medications for alcohol use disorder at hospital discharge on outcomes within 30 days, analyzing data from Medicare Part D patients hospitalized for alcohol-related issues in 2016.
- * Results showed that initiating these medications at discharge led to a 42% reduction in the risk of returning to the hospital or experiencing mortality within 30 days, indicating a significant benefit for patients.
Importance: Guidelines recommend deprescribing opioids in older adults due to risk of adverse effects, yet little is known about patient-clinician opioid deprescribing conversations.
Objective: To understand the experiences of older adults and primary care practitioners (PCPs) with using opioids for chronic pain and discussing opioid deprescribing.
Design, Setting, And Participants: This qualitative study conducted semistructured individual qualitative interviews with 18 PCPs and 29 adults 65 years or older prescribed opioids between September 15, 2022, and April 26, 2023, at a Boston-based academic medical center.
Background: Disparities in opioid prescribing among racial and ethnic groups have been observed in outpatient and emergency department settings, but it is unknown whether similar disparities exist at discharge among hospitalized older adults.
Objective: To determine filled opioid prescription rates on hospital discharge by race/ethnicity among Medicare beneficiaries.
Design: Retrospective cohort study.
Background: Timely primary care follow-up after acute care discharge may improve outcomes.
Objective: To evaluate whether post-discharge follow-up rates differ among patients discharged from hospitals directly affiliated with their primary care clinic (same-site), other hospitals within their health system (same-system), and hospitals outside their health system (outside-system).
Design: Retrospective cohort study.
Objectives: Older adults undergoing orthopedic procedures are commonly discharged from the hospital on opioids, but risk factors for postdischarge opioid-related adverse drug events (ORADEs) have not been previously examined. We aimed to identify risk factors for ORADEs after hospital discharge following orthopedic procedures.
Methods: This is a retrospective cohort study of a national sample of Medicare beneficiaries 65 years or older, who underwent major orthopedic surgery during hospitalization in 2016 and had an opioid fill within 2 days of discharge.
Importance: Asymptomatic blood pressure (BP) elevations are common in hospitalized older adults, and widespread heterogeneity in the clinical management of elevated inpatient BPs exists.
Objective: To examine the association of intensive treatment of elevated inpatient BPs with in-hospital clinical outcomes of older adults hospitalized for noncardiac conditions.
Design, Setting, And Participants: This retrospective cohort study examined Veterans Health Administration data between October 1, 2015, and December 31, 2017, for patients aged 65 years or older hospitalized for noncardiovascular diagnoses and who experienced elevated BPs in the first 48 hours of hospitalization.
Background: Atrial fibrillation is a common cause of stroke among older adults and is often first detected during hospitalization, given frequent use of cardiac telemetry.
Methods: In a 20% national sample of Medicare fee-for-service beneficiaries, we identified patients aged 65-or-older newly diagnosed with atrial fibrillation while hospitalized in 2016. Our primary outcome was an oral anticoagulant claim within 7-days of discharge.
Background: Hospitalizations related to the consequences of opioid use are rising. National guidelines directing in-hospital opioid use disorder (OUD) management do not exist. OUD treatment guidelines intended for other treatment settings could inform in-hospital OUD management.
View Article and Find Full Text PDFHospital-based clinicians frequently care for patients with opioid withdrawal or opioid use disorder (OUD) and are well-positioned to identify and initiate treatment for these patients. With rising numbers of hospitalizations related to opioid use and opioid-related overdose, the Society of Hospital Medicine convened a working group to develop a Consensus Statement on the management of OUD and associated conditions among hospitalized adults. The guidance statement is intended for clinicians practicing medicine in the inpatient setting (e.
View Article and Find Full Text PDFThis survey study aimed to provide a contemporary appraisal of advanced practice provider (APP) practice and to summarize perceptions of the benefits and challenges of integrating APPs into adult academic hospital medicine (HM) groups. We surveyed leaders of academic HM groups. We received responses from 43 of 86 groups (50%) surveyed.
View Article and Find Full Text PDFBackground: Patients with dementia are frequently hospitalized and may face barriers in post-discharge care.
Objective: To determine whether patients with dementia have an increased risk of adverse outcomes following discharge.
Design: Retrospective cohort study.
Objective: To assess trends in HbA1c and appropriateness of diabetes medication use by patient health status.
Research Design And Methods: We conducted cross-sectional analysis of 2001-2018 National Health and Nutrition Examination Survey (NHANES). We included older adults age ≥65 years who had ever been told they had diabetes, had HbA1c >6.
Guidelines recommend against initiating long-acting opioids during acute hospitalization, owing to higher risk of overdose and morbidity compared to short-acting opioid initiation. We investigated the incidence of long-acting opioid initiation following hospitalization in a retrospective cohort of Medicare beneficiaries with an acute care hospitalization in 2016 who were ≥65 years old, did not have cancer or hospice care, and had not filled an opioid prescription within the preceding 90 days. Among 258,193 hospitalizations, 47,945 (18.
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