Risk factors for potentially avoidable readmissions due to end-of-life care issues

BACKGROUND Repeated hospitalizations are frequent toward the end of life, where each admission should be an opportunity to initiate advance-care planning to high-risk patients. OBJECTIVE To identify the risk factors for having a 30-day potentially avoidable readmission due to end-of-life care issues among all medical patients. DESIGN Nested case-control study. SETTING/PATIENTS All 10,275 consecutive discharges from any medical service of an academic tertiary medical center in Boston, Massachusetts between July 1, 2009 and June 30, 2010. MEASUREMENTS A random sample of all the potentially avoidable 30-day readmissions was independently reviewed by 9 trained physicians to identify the ones due to end-of-life issues. RESULTS Among 534, 30-day potentially avoidable readmission cases reviewed, 80 (15%) were due to an end-of-life care issue. In multivariable analysis, the following risk factors were significantly associated with a 30-day potentially avoidable readmission due to end-of-life care issues: number of admissions in the previous 12 months (odds ratio [OR]: 1.10 per admission, 95% confidence interval [CI]: 1.02-1.20), neoplasm (OR: 5.60, 95% CI: 2.85-10.98), opiate medications at discharge (OR: 2.29, 95% CI: 1.29-4.07), Elixhauser comorbidity index (OR: 1.16 per 5-point increase, 95% CI: 1.10-1.22). The discrimination of the model (C statistic) was 0.85. CONCLUSIONS In a medical population, we identified 4 main risk factors that were significantly associated with 30-day potentially avoidable readmission due to end-of-life care issues, producing a model with very good to excellent discrimination. Patients with these risk factors might benefit from palliative care consultation prior to discharge in order to improve end-of-life care and possibly reduce unnecessary rehospitalizations.

External validation of the Hospital-patient One-year Mortality Risk (HOMR) model for predicting death within 1 year after hospital admission

BACKGROUND Predicting long-term survival after admission to hospital is helpful for clinical, administrative and research purposes. The Hospital-patient One-year Mortality Risk (HOMR) model was derived and internally validated to predict the risk of death within 1 year after admission. We conducted an external validation of the model in a large multicentre study. METHODS We used administrative data for all nonpsychiatric admissions of adult patients to hospitals in the provinces of Ontario (2003-2010) and Alberta (2011-2012), and to the Brigham and Women's Hospital in Boston (2010-2012) to calculate each patient's HOMR score at admission. The HOMR score is based on a set of parameters that captures patient demographics, health burden and severity of acute illness. We determined patient status (alive or dead) 1 year after admission using population-based registries. RESULTS The 3 validation cohorts (n = 2,862,996 in Ontario, 210 595 in Alberta and 66,683 in Boston) were distinct from each other and from the derivation cohort. The overall risk of death within 1 year after admission was 8.7% (95% confidence interval [CI] 8.7% to 8.8%). The HOMR score was strongly and significantly associated with risk of death in all populations and was highly discriminative, with a C statistic ranging from 0.89 (95% CI 0.87 to 0.91) to 0.92 (95% CI 0.91 to 0.92). Observed and expected outcome risks were similar (median absolute difference in percent dying in 1 yr 0.3%, interquartile range 0.05%-2.5%). INTERPRETATION The HOMR score, calculated using routinely collected administrative data, accurately predicted the risk of death among adult patients within 1 year after admission to hospital for nonpsychiatric indications. Similar performance was seen when the score was used in geographically and temporally diverse populations. The HOMR model can be used for risk adjustment in analyses of health administrative data to predict long-term survival among hospital patients.

Tending the Vineyard: Maritime Religion on Martha's Vineyard from 1824-1978

The first part of this paper will give a brief introduction to maritime missiology, the second section will trace the beginnings of the Boston Seaman’s Friend Society in the nineteenth century and the third will focus on the Vineyard Haven branch of that work well into the twentieth century. Using source material from the American Seamen’s Friend Society - there is a 5,000 document collection of the ASFS papers in the G.W. Blunt White Library at Mystic Seaport, the Boston Seaman’s Friend Society - whose papers are mostly in the Congregational House on Beacon Hill in Boston, and other secondary works from the nineteenth and twentieth century. I am especially indebted to George Wiseman’s book, They Kept the Lower Lights Burning, Wiseman was the pastor of Trinity Methodist Episcopal Church in Oak Bluff during WWII and the son-in-law of Austin Tower. This presentation will look at the many facets that made up religious work among seafarers.

Ms.Ff.F.Stoltze 3. 197 - Brief von Franz Müller an Friedrich Stoltze

Glückwünsche zum 70. Geburtstag, Humoristischer Verein in Boston, Bitte um Übersendung seiner Gedichte

'Lo sabía, lo sabía, a los pibes los mató la Policía' : Protestas en casos de violencia policial: familiares y militantes en el caso de Damián Lucero

El artículo que aquí presentamos constituye una reflexión en torno a las acciones colectivas de protesta llevadas adelante con motivo del asesinato de Damián Lucero a manos de efectivos de la Policía de la Provincia de Buenos Aires, en un barrio de la zona sur de la Ciudad de La Plata en el año 2007. El trabajo aborda las sucesivas acciones de protesta en reclamo de "justicia" que tuvieron lugar con posterioridad a la muerte de Damián, a los fines de identificar a los actores presentes y las diferentes significaciones que estos le otorgan a su presencia en el espacio público, a los horizontes de politización del reclamo y a las concepciones sobre el accionar policial que subyacen. Identificando la tensión presente entre "familiares" y "militantes de organizaciones de derechos humanos", este artículo se nutre de una doble vertiente analítica: las teorías de la acción colectiva (o movimientos sociales) y los estudios en torno las conformaciones institucionales de las policías en la Argentina democrática.

'Lo sabía, lo sabía, a los pibes los mató la Policía' : Protestas en casos de violencia policial: familiares y militantes en el caso de Damián Lucero

El artículo que aquí presentamos constituye una reflexión en torno a las acciones colectivas de protesta llevadas adelante con motivo del asesinato de Damián Lucero a manos de efectivos de la Policía de la Provincia de Buenos Aires, en un barrio de la zona sur de la Ciudad de La Plata en el año 2007. El trabajo aborda las sucesivas acciones de protesta en reclamo de "justicia" que tuvieron lugar con posterioridad a la muerte de Damián, a los fines de identificar a los actores presentes y las diferentes significaciones que estos le otorgan a su presencia en el espacio público, a los horizontes de politización del reclamo y a las concepciones sobre el accionar policial que subyacen. Identificando la tensión presente entre "familiares" y "militantes de organizaciones de derechos humanos", este artículo se nutre de una doble vertiente analítica: las teorías de la acción colectiva (o movimientos sociales) y los estudios en torno las conformaciones institucionales de las policías en la Argentina democrática.

'Lo sabía, lo sabía, a los pibes los mató la Policía' : Protestas en casos de violencia policial: familiares y militantes en el caso de Damián Lucero

El artículo que aquí presentamos constituye una reflexión en torno a las acciones colectivas de protesta llevadas adelante con motivo del asesinato de Damián Lucero a manos de efectivos de la Policía de la Provincia de Buenos Aires, en un barrio de la zona sur de la Ciudad de La Plata en el año 2007. El trabajo aborda las sucesivas acciones de protesta en reclamo de "justicia" que tuvieron lugar con posterioridad a la muerte de Damián, a los fines de identificar a los actores presentes y las diferentes significaciones que estos le otorgan a su presencia en el espacio público, a los horizontes de politización del reclamo y a las concepciones sobre el accionar policial que subyacen. Identificando la tensión presente entre "familiares" y "militantes de organizaciones de derechos humanos", este artículo se nutre de una doble vertiente analítica: las teorías de la acción colectiva (o movimientos sociales) y los estudios en torno las conformaciones institucionales de las policías en la Argentina democrática.