Preventing the Rebound

摘要

American health care is the costliest in the world and one of the most inefficient. The Centers for Disease Control estimate that $2.34 trillion were spent in 2008 in health care.1 Hospital care is the most expensive part of our medical system, accounting for one third of total health care expenditures (Figure 1). Moreover, the costs of hospital care have increased by 4.5% to 7.8% annually throughout the last decade. About 2.2 million hospital discharges in 2009 were labeled with neurological diagnoses (Table 1), or roughly 1 out of every 18 patients treated in hospitals.2 Hospital read-missions may have a negative impact on clinical outcomes, annulling any gains made during the previous hospitaliza-tion. Readmissions are also costly, as the average cost of a hospitalization for a neurological problem is $38 559. These figures represent both a challenge and an opportunity for neurohospitalists. Yet, the available medical literature offers scarce guidance regarding the main causes of clinical deterioration post-discharge.