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The research appears online in The Annals of Internal Medicine on December 27, 2016. The Hospital Readmissions Reduction Program was enacted into law in 2010 and implemented in 2012 in response to the high numbers of patients who were readmitted within 30 days of their initial discharge from the hospital after treatment for several common conditions — including heart failure, pneumonia and acute myocardial infarction (heart attack). While some readmissions may be unavoidable, there was evidence of wide variation in hospitals’ readmission rates before the ACA, suggesting that patients admitted to certain hospitals were more likely to experience readmissions compared to other hospitals. “Hospital readmissions represent a significant portion of potentially preventable medical expenditures, and they can take a physical and emotional toll on patients and their families,” said co-senior author Robert W. Yeh, MD, MBA, Director of the Smith Center for Outcomes Research in Cardiology at BIDMC and Associate Professor of Medicine at Harvard Medical School. “The Affordable Care Act sought to introduce financial incentives to motivate hospitals, especially the poorest performing ones, to reduce their readmission rates, and only the data could tell us if and how well it worked.” “We know that the national hospital readmission rate has been declining since passage cheers of the Affordable Care Act, and our team wanted to assess whether this improvement was driven by the best-performing hospitals alone, or if all groups improved,” said first author Jason H. Wasfy, MD, MPhil, who is Director of Quality and Analytics at the Massachusetts General Hospital Heart Center and Instructor in Medicine at Harvard Medical School. The researchers examined Medicare fee-for-service hospitalization data from more than 2,800 hospitals across the country between 2000 and 2013. Based on 30-day readmission rates after initial hospitalization for acute myocardial infarction, congestive heart failure or pneumonia, the researchers categorized hospitals into one of four groups based on the penalties they had incurred under the Hospital Readmissions Reduction Program: highest performance (0% penalty), average performance (greater than 0% but less than 0.5% penalty), low performance (equal to or greater than 0.5% but less than 0.99% penalty), and lowest performance (equal to or greater than 0.99% penalty). “We analyzed data from more than 15 million Medicare discharges,” said co-senior author Francesca Dominici, PhD, Professor of Biostatistics and Senior Associate Dean for Research at Harvard T.H.
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When the songs shimmer in twisting riffs or in singer Dimitri Giannopoulos’s sweet, sad voice they’re less like the flash of a Christmas tree and more like the glare off a snowbank. Don’t mistake the crawling pace of the band’s self-titled album for sluggishness; rather, the songs feel cautiously measured and patiently curious. Horse Jumper of Love by Horse Jumper of Love Horse Jumper Of Love’s opener, “Ugly Brunette,” is a woozy song about guilt and youth. In an email to NPR Music, Giannopoulos says he wrote the song as an apology, of sorts, for childhood misbehavior. “I was a very anxious child,” he says, “and I had a lot of mood swings from my diabetes [and] blood sugars and could be pretty bratty.” Giannopoulos’s strength as a lyricist comes from the way tiny personal details appear in his songs; he says “Ugly Brunette,” for example, was first inspired by thinking about a shirt he lost as a kid on a family trip. Article continues after sponsorship Despite its intimate subject matter, “Ugly Brunette” roars like a force of nature. In its moments of climax, the song sounds the way it feels to stand on your street in the middle of a blizzard: Thick walls of guitar and bass crunch like boots on snow, while drums seem to alternate between slipping on ice and finding their footing. Crank it up loud enough in your headphones, and the song’s unwieldy main riff feels obliterating but just briefly, before it staggers and crashes. Giannopoulos’s voice isn’t the center of the song, but his tender delivery complements the start-stop anxiety of the band. The result is all muscle, wielded with self-conscious sentiment.
For the original version including any supplementary images or video, visit http://www.npr.org/2016/12/27/506468984/songs-we-love-horse-jumper-of-love-ugly-brunette?utm_medium=RSS&utm_campaign=rock