We analyzed 1-year follow-up mortality both pre- and post-GAP and compared the mortality decline post-GAP with discharge contract use according to tertile.
CONCLUSIONS: Increased hospital utilization of the standard discharge contract as part of the GAP program is associated with decreased 1-year mortality in Medicare patient populations with AMI.
We aggregated the hospitals into 3 tertiles based on the rates of discharge contract use: 0% to 8.4% (tertile 1), >8.4% to 38.0% (tertile 2), and >38.0% to 61.1% (tertile 3).
Hospital efforts to promote adherence to guideline-based care tools such as the discharge contract used in GAP may result in mortality reductions for their patient populations at 1 year.
After multivariate adjustment, discharge contract use was significantly associated with decreased 1-year mortality in tertile 2 (odds ratio 0.43, 95% CI 0.22-0.84) and tertile 3 (odds ratio 0.45, 95% CI 0.27-0.75).
It is unknown whether hospitals that are more successful in using the standard discharge contract--a key component of GAP that emphasizes guideline-based medications, lifestyle modification, and follow-up planning--experience a proportionally greater improvement in patient outcomes.
It may well be that a plaintiff, upon defendant's breach may offer the discharged contract as evidence of the value of that for which he is seeking recovery.
After his discharge, he contracted pneumonia and became anemic.
Full range of discipline, discharge and contract interpretation issues.
Because of the seller's right to cure, however, the buyer's rejection does not necessarily discharge the contract.
He represents employers throughout the United States in bench and jury trials in state and federal courts, administrative hearings, arbitrations, and appellate courts in matters arising under federal and state antidiscrimination laws, the FLSA, FMLA, the Sarbanes-Oxley Act, labor management relations laws, and diverse state law wrongful discharge, statutory, contract, and tort claims.
