Home hospital as a disposition for older adults from the emergency department: Benefits and opportunities.

The $1 trillion industry of acute hospital care in the United States is shifting from inside the walls of the hospital to patient homes. To tackle the limitations of current hospital care in the United States, on November 25, 2020, the Center for Medicare & Medicaid Services announced that the acute hospital care at home waiver would reimburse for "home hospital" services. A "home hospital" is the home-based provision of acute services usually associated with the traditional inpatient hospital setting. Prior work suggests that home hospital care can reduce costs, maintain quality and safety, and improve patient experiences for select acutely ill adults who require hospital-level care. However, most emergency physicians are unfamiliar with the evidence of benefits demonstrated by home hospital services, especially for older adults. Therefore, the lead author solicited narrative inputs on this topic from selected experts in emergency medicine and home hospital services with clinical experience, publications, and funding on home hospital care. Then we sought to identify information most relevant to the practice of emergency medicine. We outline the proven and potential benefits of home hospital services specific to older adults compared to traditional acute care hospitalization with a focus on the emergency department.

Injury deaths of US citizens abroad: new data source, old travel problem.

BACKGROUND: Global travel continues to increase, including among US citizens. The global burden of injuries and violence, accounting for approximately 5 million deaths worldwide in 2000, is also growing. Travelers often experience heightened risk for this biosocial disease burden. This study seeks to further describe and improve our understanding of the variable risk of travel-related injury and death. METHODS: Information on US civilian citizen deaths from injury while abroad was obtained from the US Department of State Web site. This information was categorized into regional and causal groupings. The groupings were compared to each other and to injury deaths among citizens in their native countries. RESULTS: From 2004 to 2006, there were 2,361 deaths of US citizens overseas due to injury. Of these US citizen injury deaths, 50.4% occurred in the Americas region. Almost 40% (37.8%) of US citizen injury deaths in the low- to middle-income Americas were due to vehicle crashes compared to about half that (18.9%) (proportional mortality ratio [PMR] = 1.72, 95% confidence interval [CI] 1.59-1.62) for low- to middle-income Americas citizen injury deaths. Similar differences between US citizen injury death abroad and the in-country distributions were also found for vehicle crashes in Europe (35.9% vs 16.5%, PMR = 2.17, 95% CI 1.78-2.64; p < 0.0005), for drowning deaths in the Americas (13.1% vs 4.6%, PMR = 2.67, 95% CI 2.29-3.11) and many island nations (63.5% vs 3.5%, PMR = 11.38, 95% CI 8.17-15.84), and for homicides in the low- to middle-income European countries (16.9% vs 10.5%, PMR = 1.52, 95% CI .90-2.57). CONCLUSIONS: US citizens should be aware of regional variation of injury deaths in foreign countries, especially for motor vehicle crashes, drowning, and violence. Improved knowledge of regional variations of injury death and risk for travelers can further inform travelers and the development of evidence-based prevention programs and policies. The State Department Web site is a new data source that furthers our understanding of this challenging travel-related health issue.

Graduated driver licensing policy in the Great Lakes states: current benefits and future potential.

BACKGROUND: Motor vehicle crashes are the leading cause of teenage deaths in the United States. Graduated Driver Licensing (GDL) policies effectively decrease teenage crash deaths. Emerging research is identifying the most effective components of GDL. This study examines GDL policies across 6 Great Lakes states, describing the beneficial impact, and investigating how evidence-based policy modifications could further reduce teenage driving deaths and injuries. METHODS: GDL policies were reviewed in 6 Great Lakes states (Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin). Incidence rate ratios for fatal and injury crashes for 16-year-old drivers were obtained from the Nationwide Review of GDL Study. Ratios were applied to the fatal and injury crashes reported from each state between 2002 and 2006 for 16-year-old drivers. The potential impact (crashes avoided) for each state was determined based on the state using a 3-phase GDL policy (a learner and intermediate stage prior to full licensure). In addition, the impact on crash reductions for each state if they had employed 5 of the recommended GDL components was determined. RESULTS: All 6 states had a 3-phase GDL policy, resulting in potential avoidance of 124 fatal and more than 21,000 injury crashes. The 6 states had 1 to 3 of the qualifying GDL components. If these states had adopted 5 of the qualifying components, an additional 309 fatal and more than 27,000 injury crashes could have been avoided. CONCLUSION: Three-phase GDL policy is effective at saving the lives of teenage drivers and vehicle occupants; evidence-based modification of GDL has the potential to further reduce teenage motor vehicle crash deaths and injuries.