RESUMO
INTRODUCTION: Medicare patients account for over 50% of hospital days at a cost of over $1 trillion per year. Yet, hospitalization of older adults often results in poor outcomes. We evaluated the role of geriatrician-hospitalists in the care of older adults. Materials and methods A retrospective cohort study was conducted in a 764-bed tertiary care hospital with patients 65 and older admitted to medicine. Geriatrician-hospitalists care was compared to usual care by non-geriatrician hospitalists (staff and non-staff). Outcome measures included length of stay (LOS) and 30-day readmissions. Process measures included geriatric-focused care practices, such as early mobilization, safety precautions, delirium management, use of potentially inappropriate medications and documentation of advanced directives as well as discharge disposition. RESULTS: Of the 10,529 patients, 2949 (28.0%) were cared for by staff hospitalists, 7181 (68.2%) by non-staff hospitalists and 399 (3.79%) by geriatrician-hospitalists. Patients cared for by geriatrician-hospitalists were significantly older with more comorbidities than those admitted to staff and non-staff hospitalists (average age: 86.3, 79.7, and 80.3, respectively, pâ¯<â¯0.0001; Charlson Comorbidity Index: 7.46, 7.01, and 7.17, respectively, pâ¯=â¯0.0005). Multivariate analysis showed no difference in LOS, 30-day readmissions, and discharge disposition. In terms of care practices, significant differences were found for the following: time to PT (pâ¯<â¯0.0001), duration of indwelling bladder catheters (pâ¯=â¯0.018), documentation of Do-Not-Resuscitate (pâ¯<â¯0.0001), benzodiazepine use (pâ¯<â¯0.0001) and anticholinergics (pâ¯=â¯0.0029), respectively. CONCLUSIONS: As the population continues to age at unprecedented rates and hospitals struggle to meet the demands and expectations, geriatrician-hospitalists may improve care practices important for older adult care management.
Assuntos
Geriatras , Serviços de Saúde para Idosos/organização & administração , Médicos Hospitalares , Hospitalização/estatística & dados numéricos , Papel do Médico , Padrões de Prática Médica/estatística & dados numéricos , Melhoria de Qualidade/organização & administração , Idoso , Idoso de 80 Anos ou mais , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Serviços de Saúde para Idosos/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Análise Multivariada , Avaliação de Resultados em Cuidados de Saúde , Readmissão do Paciente/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Estados UnidosRESUMO
Pomalidomide is an analog of thalidomide with immunomodulatory, anti-angiogenic, and anti-neoplastic activity indicated for the treatment of multiple myeloma refractory to at least two prior therapies. The incidence for renal failure was <5% in a single phase II study of pomalidomide and dexamethasone in patients with multiple myeloma that failed both lenalidomide and bortezomib therapy. We report a case suggesting crystal nephropathy as the mechanism for acute kidney injury in pomalidomide and fluoroquinolone use.