NURS 6531 Final, part one
A small, rural hospital is part of an Accountable Care Organization (ACO) and is designated a
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s a Level 1 ACO. What is part of this designation? p. 2
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a. Bonuses based on achievement of benchmarks
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b. Care coordination for chronic diseases
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c. Standards for minimum cash reserves
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d. Strict requirements for financial reporting - ANS>>ANS: A
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A Level 1 ACO has the least amount of financial risk and requirements, but receives shared
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savings bonuses based on achievement of benchmarks for quality measures and expenditure
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s. Care coordination and minimum cash reserves standards are part of Level 2 ACO require
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ments. Level 3 ACOs have strict requirements for financial reporting.
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What was an important finding of the Advisory Board survey of 2014 about primary care pr
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eferences of patients? p. 2 uu uu uu uu
a. Associations with area hospitals
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b. Costs of ambulatory care
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c. Ease of access to care
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d. The ratio of providers to patients - ANS>>ANS: C
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As part of the 2014 survey, the Advisory Board learned that patients desired 24/7 access to
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ucare, walk- uu
in settings and the ability to be seen within 30 minutes, and care that is close to home. Ass
uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu
ociations with hospitals, costs of care, and the ratio of providers to patients were not part o
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f these results.
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Which assessments of care providers are performed as part of the value-
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based purchasing (VBP) initiative? (Select all that apply.) p. 1
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,a. Appraising costs per case of care for Medicare patients
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b. Assessing patients' satisfaction with hospital care
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c. Evaluating available evidence to guide clinical care guidelines
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d. Monitoring mortality rates of all patients with pneumonia
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e. Requiring advanced IT standards and minimum cash reserves - ANS>>ANS: A, B, D
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Value-
based purchasing looks at five domain areas of processes of care, including efficiency of car
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e (cost per case), experience of care (patient satisfaction measures), and outcomes of care (
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mortality rates for certain conditions). Evaluation of evidence to guide clinical care is part of
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evidence-based practice. The requirements for IT standards and financial status are
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part of Accountable Care Organization standards
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What is the purpose of Level II research? p. 6
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a. To define characteristics of interest of groups of patients
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b. To demonstrate the effectiveness of an intervention or treatment
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c. To describe relationships among characteristics or variables
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d. To evaluate the nature of relationships between two variables - ANS>>ANS: C
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Level II research is concerned with describing the relationships among characteristics or vari
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ables. Level I research is conducted to define the characteristics of groups of patients. Level
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II research evaluates the nature of the relationships between variables. Level IV
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research is conducted to demonstrate the effectiveness of interventions or treatments.
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Which is the most appropriate research design for a Level III research study? p. 6
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a. Epidemiological studies
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b. Experimental design
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c. Qualitative studies
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d. Randomized clinical trials - ANS>>ANS: B
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,The experimental design is the most appropriate design for a Level III study. Epidemiological
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studies are appropriate for Level II studies. Qualitative designs are useful for Level I studies.
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Randomized clinical trials are used for Level IV studies.
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What is the purpose of clinical research trials in the spectrum of translational research? p. 6
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a. Adoption of interventions and clinical practices into routine clinical care
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b. Determination of the basis of disease and various treatment options
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c. Examination of safety and effectiveness of various interventions
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d. Exploration of fundamental mechanisms of biology, disease, or behavior - ANS>>ANS: C
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Clinical research trials are concerned with determining the safety and effectiveness of interv
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entions. Adoption of interventions and practices is part of clinical implementation. Determin
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ation of the basis of disease and treatment options is part of the preclinical research phase.
uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu
Exploration of the fundamental mechanisms of biology, disease, or behavior is part
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of the basic research stage.
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Which statement made by a health care provider demonstrates the most appropriate under
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standing for the goal of a performance report?
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a. "This process allows me to critique the performance of the rest of the staff."
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b. "Most organizations require staff to undergo a performance evaluation yearly."
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c. "It is hard to be personally criticized but that's how we learn to change."
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d. "The comments should help me improve my management skills." - ANS>>ANS: D
uu uu uu uu uu uu uu uu uu uu uu uu
The goal of the performance report is to provide guidance to staff in the areas of professio
uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu
nal development, mentoring, and leadership development. A peer review is written by other
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s who perform similar skills (peers). The remaining options may be true but do not provide
uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu
evidence of understanding of the goal of this professional requirement.
uu uu uu uu uu uu uu uu uu
Which assessment question would a health care provider ask when engaging in the previsit
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stage of the new model for primary care? (Select all that apply.)
uu uu uu uu uu uu uu uu uu uu uu
a. "Are you ready to discuss some of the community resources that are available?"
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, b. "Are you experiencing any side effects from your newly prescribed medications?"
uu uu uu uu uu uu uu uu uu uu uu
c. "Do you anticipate any problems with adhering to your treatment plan?"
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d. "Are you ready to discuss the results of your laboratory tests?"
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e. "Do you have any questions about the lab tests that have been ordered for you?" -
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ANS>>ANS: B, C, E
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The nursing responsibilities in the previsit stage include assessing the patient's tolerance of
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prescribed medications, understanding of existing treatment plan, and education about requi
uu uu uu uu uu uu uu uu uu uu
red lab testing. The primary care provider is responsible for screening lab data and
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discussing community resources during the actual visit.
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What is the Quadruple Aim? p. 15 - ANS>>1) Improved patient satisfaction
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2) Reduce per capita costs
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3) Improve population health
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4) Improve patient care team experience
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To reduce adverse events associated with care transitions, the Centers for Medicare and Me
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dicaid Service have implemented which policy?
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a. Mandates for communication among primary caregivers and hospitalists
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b. Penalties for failure to perform medication reconciliations at time of discharge
uu uu uu uu uu uu uu uu uu uu uu
c. Reduction of payments for patients readmitted within 30 days after discharge
uu uu uu uu uu uu uu uu uu uu uu
d. Requirements for written discharge instructions for patients and caregivers - ANS>>ANS: C
uu uu uu uu uu uu uu uu uu uu uu uu
As a component of the Affordable Care Act, the Centers for Medicare and Medicaid Service
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developed the Readmissions Reduction Program reducing payments for certain patients read
uu uu uu uu uu uu uu uu uu uu
mitted within 30 days of discharge. The CMS did not mandate communication, institute pen
uu uu uu uu uu uu uu uu uu uu uu uu uu
alties for failure to perform medication reconciliations, or require written discharge instructi
uu uu uu uu uu uu uu uu uu uu uu
ons.
According to multiple research studies, which intervention has resulted in lower costs and fe
uu uu uu uu uu uu uu uu uu uu uu uu uu
wer rehospitalizations in high-risk older patients?
uu uu uu uu uu
A small, rural hospital is part of an Accountable Care Organization (ACO) and is designated a
uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu
s a Level 1 ACO. What is part of this designation? p. 2
uu uu uu uu uu uu uu uu uu uu uu uu
a. Bonuses based on achievement of benchmarks
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b. Care coordination for chronic diseases
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c. Standards for minimum cash reserves
uu uu uu uu uu
d. Strict requirements for financial reporting - ANS>>ANS: A
uu uu uu uu uu uu uu uu
A Level 1 ACO has the least amount of financial risk and requirements, but receives shared
uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu
savings bonuses based on achievement of benchmarks for quality measures and expenditure
uu uu uu uu uu uu uu uu uu uu uu
s. Care coordination and minimum cash reserves standards are part of Level 2 ACO require
uu uu uu uu uu uu uu uu uu uu uu uu uu uu
ments. Level 3 ACOs have strict requirements for financial reporting.
uu uu uu uu uu uu uu uu uu
What was an important finding of the Advisory Board survey of 2014 about primary care pr
uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu
eferences of patients? p. 2 uu uu uu uu
a. Associations with area hospitals
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b. Costs of ambulatory care
uu uu uu uu
c. Ease of access to care
uu uu uu uu uu
d. The ratio of providers to patients - ANS>>ANS: C
uu uu uu uu uu uu uu uu uu
As part of the 2014 survey, the Advisory Board learned that patients desired 24/7 access to
uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu u
ucare, walk- uu
in settings and the ability to be seen within 30 minutes, and care that is close to home. Ass
uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu
ociations with hospitals, costs of care, and the ratio of providers to patients were not part o
uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu
f these results.
uu uu
Which assessments of care providers are performed as part of the value-
uu uu uu uu uu uu uu uu uu uu uu
based purchasing (VBP) initiative? (Select all that apply.) p. 1
uu uu uu uu uu uu uu uu uu
,a. Appraising costs per case of care for Medicare patients
uu uu uu uu uu uu uu uu uu
b. Assessing patients' satisfaction with hospital care
uu uu uu uu uu uu
c. Evaluating available evidence to guide clinical care guidelines
uu uu uu uu uu uu uu uu
d. Monitoring mortality rates of all patients with pneumonia
uu uu uu uu uu uu uu uu
e. Requiring advanced IT standards and minimum cash reserves - ANS>>ANS: A, B, D
uu uu uu uu uu uu uu uu uu uu uu uu uu
Value-
based purchasing looks at five domain areas of processes of care, including efficiency of car
uu uu uu uu uu uu uu uu uu uu uu uu uu uu
e (cost per case), experience of care (patient satisfaction measures), and outcomes of care (
uu uu uu uu uu uu uu uu uu uu uu uu uu uu
mortality rates for certain conditions). Evaluation of evidence to guide clinical care is part of
uu uu uu uu uu uu uu uu uu uu uu uu uu uu u
evidence-based practice. The requirements for IT standards and financial status are
u uu uu uu uu uu uu uu uu uu uu
part of Accountable Care Organization standards
uu uu uu uu uu
What is the purpose of Level II research? p. 6
uu uu uu uu uu uu uu uu uu
a. To define characteristics of interest of groups of patients
uu uu uu uu uu uu uu uu uu
b. To demonstrate the effectiveness of an intervention or treatment
uu uu uu uu uu uu uu uu uu
c. To describe relationships among characteristics or variables
uu uu uu uu uu uu uu
d. To evaluate the nature of relationships between two variables - ANS>>ANS: C
uu uu uu uu uu uu uu uu uu uu uu uu
Level II research is concerned with describing the relationships among characteristics or vari
uu uu uu uu uu uu uu uu uu uu uu uu
ables. Level I research is conducted to define the characteristics of groups of patients. Level
uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu
II research evaluates the nature of the relationships between variables. Level IV
uu uu uu uu uu uu uu uu uu uu uu
research is conducted to demonstrate the effectiveness of interventions or treatments.
uu uu uu uu uu uu uu uu uu uu
Which is the most appropriate research design for a Level III research study? p. 6
uu uu uu uu uu uu uu uu uu uu uu uu uu uu
a. Epidemiological studies
uu uu
b. Experimental design
uu uu
c. Qualitative studies
uu uu
d. Randomized clinical trials - ANS>>ANS: B
uu uu uu uu uu uu
,The experimental design is the most appropriate design for a Level III study. Epidemiological
uu uu uu uu uu uu uu uu uu uu uu uu uu u
studies are appropriate for Level II studies. Qualitative designs are useful for Level I studies.
u uu uu uu uu uu uu uu uu uu uu uu uu uu uu u
Randomized clinical trials are used for Level IV studies.
u uu uu uu uu uu uu uu uu
What is the purpose of clinical research trials in the spectrum of translational research? p. 6
uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu
a. Adoption of interventions and clinical practices into routine clinical care
uu uu uu uu uu uu uu uu uu uu
b. Determination of the basis of disease and various treatment options
uu uu uu uu uu uu uu uu uu uu
c. Examination of safety and effectiveness of various interventions
uu uu uu uu uu uu uu uu
d. Exploration of fundamental mechanisms of biology, disease, or behavior - ANS>>ANS: C
uu uu uu uu uu uu uu uu uu uu uu uu
Clinical research trials are concerned with determining the safety and effectiveness of interv
uu uu uu uu uu uu uu uu uu uu uu uu
entions. Adoption of interventions and practices is part of clinical implementation. Determin
uu uu uu uu uu uu uu uu uu uu uu
ation of the basis of disease and treatment options is part of the preclinical research phase.
uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu
Exploration of the fundamental mechanisms of biology, disease, or behavior is part
uu uu uu uu uu uu uu uu uu uu uu uu
of the basic research stage.
uu uu uu uu
Which statement made by a health care provider demonstrates the most appropriate under
uu uu uu uu uu uu uu uu uu uu uu uu
standing for the goal of a performance report?
uu uu uu uu uu uu uu
a. "This process allows me to critique the performance of the rest of the staff."
uu uu uu uu uu uu uu uu uu uu uu uu uu uu
b. "Most organizations require staff to undergo a performance evaluation yearly."
uu uu uu uu uu uu uu uu uu uu
c. "It is hard to be personally criticized but that's how we learn to change."
uu uu uu uu uu uu uu uu uu uu uu uu uu uu
d. "The comments should help me improve my management skills." - ANS>>ANS: D
uu uu uu uu uu uu uu uu uu uu uu uu
The goal of the performance report is to provide guidance to staff in the areas of professio
uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu
nal development, mentoring, and leadership development. A peer review is written by other
uu uu uu uu uu uu uu uu uu uu uu uu
s who perform similar skills (peers). The remaining options may be true but do not provide
uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu
evidence of understanding of the goal of this professional requirement.
uu uu uu uu uu uu uu uu uu
Which assessment question would a health care provider ask when engaging in the previsit
uu uu uu uu uu uu uu uu uu uu uu uu uu uu
stage of the new model for primary care? (Select all that apply.)
uu uu uu uu uu uu uu uu uu uu uu
a. "Are you ready to discuss some of the community resources that are available?"
uu uu uu uu uu uu uu uu uu uu uu uu uu
, b. "Are you experiencing any side effects from your newly prescribed medications?"
uu uu uu uu uu uu uu uu uu uu uu
c. "Do you anticipate any problems with adhering to your treatment plan?"
uu uu uu uu uu uu uu uu uu uu uu
d. "Are you ready to discuss the results of your laboratory tests?"
uu uu uu uu uu uu uu uu uu uu uu
e. "Do you have any questions about the lab tests that have been ordered for you?" -
uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu
ANS>>ANS: B, C, E
uu uu uu uu
The nursing responsibilities in the previsit stage include assessing the patient's tolerance of
uu uu uu uu uu uu uu uu uu uu uu uu uu
prescribed medications, understanding of existing treatment plan, and education about requi
uu uu uu uu uu uu uu uu uu uu
red lab testing. The primary care provider is responsible for screening lab data and
uu uu uu uu uu uu uu uu uu uu uu uu uu
discussing community resources during the actual visit.
uu uu uu uu uu uu
What is the Quadruple Aim? p. 15 - ANS>>1) Improved patient satisfaction
uu uu uu uu uu uu uu uu uu uu uu
2) Reduce per capita costs
uu uu uu uu
3) Improve population health
uu uu uu
4) Improve patient care team experience
uu uu uu uu uu
To reduce adverse events associated with care transitions, the Centers for Medicare and Me
uu uu uu uu uu uu uu uu uu uu uu uu uu
dicaid Service have implemented which policy?
uu uu uu uu uu
a. Mandates for communication among primary caregivers and hospitalists
uu uu uu uu uu uu uu uu
b. Penalties for failure to perform medication reconciliations at time of discharge
uu uu uu uu uu uu uu uu uu uu uu
c. Reduction of payments for patients readmitted within 30 days after discharge
uu uu uu uu uu uu uu uu uu uu uu
d. Requirements for written discharge instructions for patients and caregivers - ANS>>ANS: C
uu uu uu uu uu uu uu uu uu uu uu uu
As a component of the Affordable Care Act, the Centers for Medicare and Medicaid Service
uu uu uu uu uu uu uu uu uu uu uu uu uu uu uu
developed the Readmissions Reduction Program reducing payments for certain patients read
uu uu uu uu uu uu uu uu uu uu
mitted within 30 days of discharge. The CMS did not mandate communication, institute pen
uu uu uu uu uu uu uu uu uu uu uu uu uu
alties for failure to perform medication reconciliations, or require written discharge instructi
uu uu uu uu uu uu uu uu uu uu uu
ons.
According to multiple research studies, which intervention has resulted in lower costs and fe
uu uu uu uu uu uu uu uu uu uu uu uu uu
wer rehospitalizations in high-risk older patients?
uu uu uu uu uu
