Wilkinson Vest (layerrifle3)

Background Specialty palliative care (SPC) provides patient-centered care to people with serious illness and may reduce costs. Specific cost-saving functions of SPC remain unclear. Objectives (1) To assess the effect of SPC on inpatient costs and length of stay (LOS) and (2) to evaluate differences in costs by indication and timing of SPC. Design Case-control with in patients who received an SPC consultation and propensity matched controls. Setting One large U.S. integrated delivery finance system. Measurements Using administrative data, we assessed costs associated with inpatient stays, a subset of whom received an SPC consultation. Consultations were stratified by reasons based on physician discretion goals of care, pain management, hospice evaluation, nonpain symptom management, or support. The primary outcome was total operating costs and the secondary outcome was hospital LOS. Results In total, 1404 patients with SPC consultations associated with unique hospital encounters were matched with 2806 controls. Total operating costs were lower for patients who received an SPC consultation when the consultation was within 0 to 1 days of admission ($6,924 vs. $7,635, p = 0.002). Likewise, LOS was shorter (4.3 vs. 4.7 days, p less then 0.001). Upon stratification by reason, goals-of-care consultations early in the hospital stay (days 0-1) were associated with reduced total operating costs ($7,205 vs. $8,677, p less then 0.001). Costs were higher for pain management consultations ($7,727 vs. $6,914, p = 0.047). Consultation for hospice evaluation was associated with lower costs, particularly when early (hospital days 0-1 $4,125 vs. $7,415, p less then 0.001). Conclusions SPC was associated with significant cost saving and decreased LOS when occurring early in a hospitalization and used for goals-of-care and hospice evaluation.Purpose The purpose of this investigation was to measure the test-retest stability of single-word intelligibility in a group of 28 speakers with chronic apraxia of speech and aphasia. Method The Assessment of Intelligibility of Dysarthric Speech was administered twice to each participant, with samples separated by 1 week. Scoring of recorded samples was completed independently by three expert listeners using transcription and multiple-choice scoring formats. Results Percent intelligible words was very similar for the group over the two sampling times for both scoring formats (i.e., within 1.5%), with no statistically significant differences found between times. Statistically significant, very strong, positive correlations were found between sampling times for intelligibility scores. Transcription and multiple-choice scores were strongly, positively correlated, with multiple-choice scores being statistically higher. There was a statistically significant difference between mean transcription and multiple-choice scores for the group at Time 1 and Time 2. Individual performance was similar to group performance for the majority of participants. Conclusions These findings indicate that single-word intelligibility measures are stable over repeated sampling occasions. Stability was evident for transcription and multiple-choice scoring methods. Supplemental Material https//doi.org/10.23641/asha.14226737.Objectives The coronavirus disease 2019 (COVID-19) pandemic has presented extreme challenges for health care workers. This study sought to characterize challenges faced by physician mothers, compare differences in challenges by home and work characteristics, and elicit specific needs and potential solutions. Methods We conducted a mixed-methods online survey of the Physician Moms Group (PMG) and PMG COVID19 Subgroup on Facebook from April 18th to 29th, 2020. We collected structured data on personal and professional characteristics and qualitative data on home and work concerns. We analyzed qualitative data thematically and used bivariate analyses to evaluate variation in themes by frontline status and children's