Health Care Reform and Cost Control

White House Office of Management and Budget, Washington, DC, USA.
New England Journal of Medicine (Impact Factor: 55.87). 08/2010; 363(7):601-3. DOI: 10.1056/NEJMp1006571
Source: PubMed
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    • "Hospitalizations constitute one of the most expensive sources of medical expenditures in the U.S. health care system while modern rates of preventable hospitalizations due to chronic illness are increasing. Close to 20% of Medicare beneficiaries are being re-admitted to hospitals within 30 days of discharge due in part to expedited discharges and inadequate or no transition of care between the discharge physician and patient's primary care provider (Orszag & Emanuel 2010). Orszag and his colleagues note: " More than half of these readmitted patients have not seen their physician between discharge and readmission, and a recent study suggests that better coordination of care can reduce readmission rates for major chronic illness. "
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    ABSTRACT: The imperatives of the Affordable Care Act to reduce 30-day readmissions present challenges and opportunities for nurse administrators. The literature suggests success in reducing readmissions through enhancing patient-centered discharge processes, focusing on medication reconciliation, improving coordination with community-based providers, and effective patient self-management of their disease and treatment. Evidence-based interventions addressing low health literacy, when used with all patients, hold promise to promote understanding and self-management. Strategies addressing low health literacy aimed at reducing 30-day readmissions are identified and discussed.
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    ABSTRACT: Blending a highly enriched UF<sub>6</sub> gas stream with low-enrichment material reduces the excess supply of highly enriched uranium that must be closely controlled for nonproliferation of nuclear weapons. Computer simulations and feasibility experiments show that inducing fission in <sup>235</sup>U provides means for monitoring the blending process. Detecting delayed fission neutrons or gamma rays after fission products drift downstream in the gas gives a measure of <sup>235 </sup>U content and flow velocity. At very low UF<sub>6</sub> gas pressures (5 mm Hg) where the downstream signal is too weak for use, an alternative technique based on attenuation of thermal neutrons passing through the UF<sub>6</sub> gives a measure of <sup>235</sup>U content
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