Out of the hospital and into the kitchen
In a bid to help educate patients about a healthier relationship with food, 400 doctors last month attended this year's sold-out "Healthy Kitchens Healthy Lives
" conference, a four-day boot camp designed to teach clinicians cooking and nutritional skills. Now in its eighth year, the conference is a collaboration between the Harvard School of Public Health and the Culinary Institute of America. Held for four days in Napa Valley at a cost of $1,200, the conference—which is billed as "highly interactive"—has inspired Baylor medical students to hire a chef to teach them how to cook and led an outpatient physician to build a demonstration kitchen in his office to hold cooking classes for patients. Coverage of the conference appeared in the New York Times.
Read MorePosted on 04-12-2012 at 9:32 AM
PAY FOR PERFORMANCE
No mortality benefits from PFP demo
A look at outcomes of more than 250 hospitals engaged in CMS' pay-for-performance demonstration project finds that those hospitals have the same 30-day mortality rates as hospitals that haven't been participating. An NEJM study compares mortality rates of hospitals in CMS' six-year Premier project to outcomes of more than 3,300 other hospitals. Authors found that the hospitals in the demonstration project didn't post better 30-day mortality outcomes for the conditions being followed: heart attack, heart failure, pneumonia and CABG. Commentary
in Kaiser Health News points out that hospitals in the demonstration project did achieve better rates on process measures, such as giving beta-blockers to heart attack patients, than nonparticipating hospitals.
Read MorePosted on 04-10-2012 at 1:35 PM
Time to offer elderly their own ED?
A New York Times article describes a new trend designed to boost patient satisfaction scores and improve care: geriatric emergency departments, or "geri-eds." Patients sent to one of the new ED units have first been triaged in that hospital's regular emergency department and have met several requirements, including being over age 65 and having a condition of only low or moderate severity. The new units are designed to be much calmer than regular EDs, according to the article, with no blinking lights or beeping monitors and with painted "skylights" featuring blue skies and trees to mitigate sun-downing. While doctors and nurses in hospitals with geri-ed units were skeptical about them at first, clinicians have seen patient satisfaction scores rise and deep reductions in the number of patient falls and of unscheduled repeat ED visits.
Read MorePosted on 04-10-2012 at 1:34 PM
Report: Don’t order these tests, procedures
A group of nine specialty boards has released a report urging physicians to perform 45 common tests and procedures less frequently. The group, which is operating under the auspices of the American Board of Internal Medicine Foundation, includes routine ECGs during physicals and routine MRIs for back pain on its list. While some of the items on the list are thought to be used due to concerns about malpractice, critics of the list worry it will be used to restrict patient care. Read MorePosted on 04-05-2012 at 3:55 PM
In malpractice cases, winning is costly
When physicians defend themselves in malpractice cases that result in a payment to a patient, the costs of the defense go way up. According to a letter to the editor published in the New England Journal of Medicine, defense costs for those cases jumped to just over $45,000. By comparison, defenses for cases where no payment was made to patients cost around $17,000. Read MorePosted on 04-05-2012 at 3:54 PM
Are clots associated with infections?
Researchers found that in more than half of all hospitalizations for VTE in older patients, infection was present, raising the possibility that VTE may commonly be preceded by infection. According to a study in Circulation, infection was associated with a threefold risk of being hospitalized for DVT of PE. Researchers concluded that blood transfusions also appear to serve as a risk factor for venous clot. Read MorePosted on 04-05-2012 at 3:54 PM
New tool assesses strengths of hospitalist programs
A new tool designed to gauge the strengths and weaknesses of hospitalist programs will be offered free to hospitals, beginning next month. The tool, which was developed by executives at Cogent HMG, will compare the performance of individual hospitalist programs to national benchmarks in core capabilities including alignment, performance management, infrastructure, operational processes and leadership. Named the Greeno-Hawley Hospital Medicine Index, the tool was designed by Ron Greeno, MD, Cogent HMG's chief medical officer, and Beth Hawley, a Cogent HMG senior vice president.
Read MorePosted on 04-03-2012 at 12:25 PM
Should community hospitals with no cardiac surgery do PCI?
A study in NEJM that randomized patients with elective angioplasty or PCI to either a community hospital that had no cardiac surgery capability or to centers with cardiac surgery units found no difference in terms of six-week mortality or nine-month cardiac event rates. The study randomized close to 19,000 patients, with three-fourths of those receiving elective PCI in a hospital with no cardiac surgery unit. (The study enrolled patients in 60 hospitals across 10 states.) However, the authors stressed that the community hospitals providing the elective PCI with no onsite surgery backup had to meet strict criteria. Among those were being able to offer 24/7 coverage, the ability to perform at least 200 procedures a year, and transfer agreements with tertiary centers and transport services.
Read MorePosted on 04-03-2012 at 12:03 PM
Program delivers cost savings, cautionary tale
In the "if it's not broken, don't fix it" department, a tertiary center reaped major savings from an antimicrobial monitoring program, only to see costs jump again when the program was scrapped in favor of automatic infectious disease consults. A study in Infection Control and Hospital Epidemiology notes that an antibiotic stewardship program staffed by a part-time infectious diseases specialist and a pharmacist saved a large academic center about $3 million a year and, after seven years, had cut antibiotic spending almost in half. However, when the program was discontinued and replaced with automatic infectious disease consults, the hospital's spending on antibiotics over the next two years increased more than 30% with no improvement in mortality or readmission rates. To capture previous cost savings, the hospital has once again implemented a modified stewardship program.
Read MorePosted on 03-28-2012 at 11:19 AM
The obese need not apply
In what some commentators are calling the first of its kind, a Texas hospital has implemented a no-hiring policy for the obese, saying that candidates who are significantly overweight would not conform to what patients expect in health care providers. According to coverage in the Texas Tribune, Citizens Medical Center in Victoria announced the policy more than a year ago, refusing to consider employing candidates with a BMI of 35 or higher. Several hospitals around the country have implemented no-smoking policies when hiring new workers, but only Michigan and a handful of cities protect the right of obese workers to not be discriminated against in hiring. According to a Texas Hospital Association spokesperson quoted in the article, the hospital in question may run into problems because some courts have interpreted obesity as a disability that's protected by the federal Americans with Disabilities Act.
Read MorePosted on 03-28-2012 at 11:18 AM
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