An updated policy statement endorsed by the American Heart Association and American Stroke Association, published in the journal Stroke, outlined a four-tier hospital system for acute stroke care. The tiers include primary stroke centers, thrombectomy-capable stroke centers, comprehensive stroke centers and certified acute stroke-ready hospitals.

Younger patients had higher long-term mortality ratios after an ICU stay, compared with older patients, with the highest risks seen in the first year after hospital discharge, according to a study in JAMA Open Network. The mortality risk for patients ages 80 and older was similar to that of the general population.

A study in JAMA Internal Medicine found some hospitals with "Centers of Excellence" quality designations from health insurers may not have lower mortality or readmission rates for heart patients, compared with other hospitals. "Although the goal is to help guide patients to high quality hospitals that are also more cost-efficient, at this point it does not appear that these programs consistently identify such high quality hospitals," said lead author Dr. Sameed Khatana.

The number of emergency department patients who left California hospitals after seeing a doctor but before their care was complete jumped 57% from 2012 to 2017, while the median wait before admission from the ED increased by 15 minutes to 336 minutes. Experts said the increase in patients leaving against medical advice could be attributed to overcrowding, with ED trips in the state up by nearly 20% from 2012 to 2017.

Smartphone and computer apps have become ubiquitous in daily life, providing the potential to bridge EHR interoperability gaps, and rules proposed by the Office of the National Coordinator for Health IT aim to facilitate the connection of EHRs with third-party apps through application programming interfaces, says National Coordinator Donald Rucker. If the initiative succeeds, clinicians would no longer have to report quality data because insurers could extract data through APIs and apply machine learning technology to rate quality, Rucker says.

Research published in the Journal of the American Medical Informatics Association cited slow progress on interoperability as one of seven factors related to poor physician experience with EHRs. Greater government regulation, obsolete servers and software, and training and implementation were also among the factors.