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Medical law : a very short introduction
The author surveys the principles governing medical law.
Book
Readmissions, Observation, and the Hospital Readmissions Reduction Program
The ACA Hospital Readmissions Reduction Program applies penalties for high readmission rates. Among Medicare beneficiaries, rates declined after the ACA went into effect. There was no significant association between changes in observation stays and readmissions.
Hospital readmissions within 30 days after discharge have drawn national policy attention because they are very costly, accounting for more than $17 billion in avoidable Medicare expenditures,
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and are associated with poor outcomes. In response to these concerns, the Affordable Care Act (ACA), which was passed in March 2010, created the Hospital Readmissions Reduction Program. Since October 2012, the start of fiscal year (FY) 2013, the program has penalized hospitals with higher-than-expected 30-day readmission rates for selected clinical conditions. In FY 2013 and 2014, these conditions were acute myocardial infarction, heart failure, and pneumonia. Total hip or knee replacement and . . .
Journal Article
The Evolution of Patient Advocacy: From Rights to Reality
Fifty years ago, George J. Annas and Joseph Healey introduced the concept of a “patient rights advocate” in their seminal 1974 article published in the Vanderbilt Law Review. Annas expanded this vision in the ACLU Handbook, The Rights of Hospitalized Patients, later broadening its scope to all medical settings. This essay traces the evolution of patient advocacy, highlighting pivotal milestones: the advent of cancer navigators, the rise of the patient safety movement, the establishment of patient advocacy organizations, the development of Patient Advocate Offices in hospitals, and the emergence of independent advocates with board certification. It also examines the impact of advocacy on healthcare outcomes, costs, and patient-provider satisfaction, and explores future directions for this vital and growing profession.
Journal Article
Legislative compliance in coordinated care transitions: a mixed-method study of healthcare professionals' documentation and older adults' experiences
This study aimed to explore and describe how coordinated care transitions aligned with legislation when older adults are discharged from in-patient care to their homes.
A mixed-method (QUAL + qual) design was used. The core data component (QUAL) consisted of copies of 15 older adults' healthcare and social care records. The supplementary data component (qual) encompassed individual interviews. All data related to the same older adults, whose coordinated care transitions took place between January to June 2022. The analytical procedure followed a deductive thematic analysis.
Findings showed that individual care plans were often missing or inadequately documented. Documentation of older adults' participation was frequently poor and inconsistent, with many decisions made without their input. However, some documents and interviews indicated that older adults had genuinely participated. The discrepancy between documented procedures and actual experiences reveals significant variability in older adults' inclusion.
This study highlights the frequent exclusion of older adults from coordinated care transition process and deficiencies in documentation. The findings underscore the urgent need for standardized and inclusive documentation practices, as well as improved communication strategies, to ensure more person-centred care transitions, in which older adults are genuinely involved and well-informed about their care transitions.
Journal Article
The Rights of Elders in Ireland during COVID-19
Abstract
This article reflects on COVID-19 restrictions imposed on elders in Ireland through the lens of the right to private and family life (Article 8 ECHR), focusing on stay at home orders and recommendations advising elders to avoid social contact. Furthermore, we examine restrictions on visiting nursing homes given the high death toll in that setting. In our analysis, we zero in on the principles of foreseeability and proportionality, highlighting areas of concern and aspects that we submit should be considered in a proportionality assessment. Ultimately, we argue that it is a mistake to view the COVID-19 pandemic solely as an emergency. In this manner, the solutions suggested through the law - restrictions on movement and visitation bans - are too narrow and fail to address the underlying structures, such as, issues in the healthcare system, the limited home help for elderly and poor conditions in nursing homes.
Journal Article
The recognition and expectations of ex-inpatients of mental health services: A web-based questionnaire survey in Japan
Concern about mental health issues and the treatment of mentally disordered offenders attracts considerable public attention. This study aimed to gather the experiences and opinions of people who have experienced admission to a psychiatric ward in order to grasp their reaction to, and understanding of, the legislation behind the involuntary admission of psychiatric patients. A web-based questionnaire survey was conducted with a total of 379 participants, using a cross-sectional, exploratory design. The data were analyzed using a chi-squared test, Fisher's exact test, and a logistic regression analysis. According to the results, many patients were satisfied with their treatment during psychiatric admission; however, only few participants said that they had been given an adequate explanation for their involuntary treatment. Most participants expected qualified assistance after discharge, although the prospect of a regular visit from an official was not entirely supported by the participants. Patient satisfaction was relevant to the discussion of their needs after discharge and in developing a crisis plan during admission. These findings suggest that psychiatric patients accept inpatient treatment as long as they receive an adequate explanation. More qualified care such as relapse prevention would be expected to lead to better satisfaction. For them to welcome regular visits from an official, patients may need more information and discussion.
Journal Article