Internal Medicine — Weekly Evidence Brief

Comprehensive approaches to care transitions are proving effective in improving patient outcomes and reducing healthcare burdens. Interventions for older adults with multiple chronic conditions demonstrate statistically significant improvements in quality of life and a substantial reduction in hospital readmissions for up to six months post-discharge 1. Parallel efforts in medication safety, such as the Patient for Medication Safety intervention, show promising results in enhancing medication safety behaviors, health literacy, and reducing discrepancies during hospital-to-home transitions for older adults 2.

Furthermore, the strategic use of Transitional Care Management (TCM) services is critical for vulnerable populations, as billing for TCM codes is associated with significant reductions in emergency department visits and 30-day hospital readmissions among dual-eligible Medicare/Medicaid beneficiaries 3. Enhancing successful transitions for Medicare beneficiaries with serious mental illness from skilled nursing facilities to home or community settings also requires addressing patient demographics and facility characteristics, highlighting areas for targeted improvements in care coordination 4.

Optimizing clinical decision-making is essential for high-quality care, especially in complex scenarios. Presenting primary care physicians with multiple care alternatives (2 to 4 options) in clinical decision support systems significantly improves the selection of appropriate treatment plans, particularly for opioid prescribing scenarios, suggesting a direct pathway to more effective tools 5. However, careful consideration is needed when initiating treatments like oral anticoagulation in older adults with new-onset atrial fibrillation; while unadjusted models suggest appropriate patient selection by clinicians, initial prescription may not reduce ischemic stroke risk but significantly increases the hazard of major bleeding events, including intracerebral hemorrhage 6. For cancer survivors, comprehensive control of at least five cardiovascular risk factors can dramatically reduce heart failure risk, potentially normalizing it to that of individuals without cancer 7.

Addressing health disparities and supporting vulnerable populations remains a critical challenge. Patients with cardiac devices experiencing ST-elevation myocardial infarction (STEMI) often receive suboptimal care, reflected in longer door-to-balloon times and a higher 5-year all-cause mortality risk, necessitating improved care pathways for this group 8. Significant racial and ethnic disparities also persist in end-of-life care for older adults with dementia, with non-Hispanic Black and Hispanic decedents receiving more intensive care and lower hospice utilization, even when treated by the same physician, indicating systemic inequities that demand attention 9. Public health initiatives are also being informed by trends in hallucinogen-related emergency department visits and hospital admissions, alongside critical efforts to expand buprenorphine treatment for opioid use disorder into non-addiction specialty settings to improve care access 1011.