Published in the April 2011 issue of Today’s Hospitalist
Want lower AMI mortality? Improve organizational skills
A STUDY THAT FOCUSED ON what distinguishes hospitals with the lowest mortality rates from acute myocardial infarction from those with the highest rates found that hospital culture and organizational cohesion made the difference.
Researchers writing in the March 15 issue of Annals of Internal Medicine talked to staff at 11 hospitals; some were in the top 5% in terms of low AMI mortality, and some were in the bottom 5%. Researchers reported finding a two-fold difference in mortality rates between those two groups.
Both types of hospitals had similar procedures and protocols “and both types of hospitals had hospitalists. But researchers found that hospitals with the lowest AMI mortality shared key organizational components.
Those included having much more consistent engagement of senior management in AMI care, backed by both financial and nonfinancial resources; better care coordination and communication among physician groups, nursing and pharmacy; a much stronger culture of holding regular committee meetings; and a higher capacity for problem-solving.
Stent patients: no benefit from high-dose clopidogrel
A RANDOMIZED TRIAL comparing cardiovascular event rates for patients who received drug-eluting stents and took either high-dose or low-dose clopidogrel post-PCI found that high-dose clopidogrel at six months conferred no advantage. Patients in both groups experienced the same rates of mortality, stent clotting and MI.
Patients in the high-dose group received 600 mg the first day and then 150 mg daily. The patients in the low-dose group received no initial loading dose and 75 mg a day. (Patients in both groups were also on aspirin.) Researchers also found no difference in the six-month rate of moderate or severe bleeding between the two groups.
The authors concluded that the data provided no evidence for uniformly moving PCI patients with drug-eluting stents to high-dose antiplatelet therapy. They did point out, however, that future studies may find some value for personalized therapy based on platelet function testing.
The study appeared in the March 16 Journal of the American Medical Association.
Primary care is failing to monitor opiate use
A RETROSPECTIVE REVIEW of eight primary care practices revealed that very few patients being prescribed opioids for chronic non-cancer pain were undergoing any monitoring, even when patients were most likely to misuse the drugs.
The study looked at how often primary care practices used any of three risk reduction strategies: urine testing, regular office visits and restrictions on early refills. The authors found that only 8% of patients taking long-term opioids, which was defined as getting three or more monthly prescriptions within a six-month period, underwent urine testing. Only half (49.8%) made regular office visits, and more than three-fourths (76.6%) had received early refills.
Risk factors for drug misuse were being younger than 45; having a drug, alcohol or mental health disorder; and tobacco use. Patients with a drug use disorder did have a higher rate of urine testing, but they also had more early refills of prescriptions. The study was published online by the Journal of General Internal Medicine.
Loop diuretics: bolus vs. continuous infusion
A RANDOMIZED TRIAL that compared furosimide boluses to continuous infusion for hospitalized patients with acute decompensated heart failure as well as low- vs. high-dose furosimide found similar outcomes and symptoms among all four patient groups.
The study, which enrolled just over 300 patients, gave patients either a bolus every 12 hours or continuous infusion. Researchers also compared low-dose furosimide, which was equal to a patient’s oral dose, to high-dose, which was 2.5 times the patient’s regular oral dose.
In looking at the results from both the bolus vs. infusion and dosing strategies, the authors found no difference in LOS or readmission rates, nor any difference in patient-reported symptoms or in the mean change in patients’ creatinine levels.
While a high-dose regimen was associated with more net fluid loss and better secondary outcomes, those patients also had more transient problems with kidney function. The study was published in the March 3 issue of the New England Journal of Medicine.
Hospital discipline not linked to board actions
THE PUBLIC WATCHDOG GROUP PUBLIC CITIZEN has reported that 55% of U.S. physicians censured by their hospital between 1990 and 2009 received no action from their state licensing board. The group’s state-by-state analysis found that in some states, more than 70% of doctors who had been disciplined by their hospital received no licensure actions.
The claim was based on the group’s analysis of reports from the National Practitioner Data Base (NPDB). The group found that more than 10,600 physicians had had their hospital privileges revoked or restricted. While hospitals are required to report such disciplinary actions to state licensing boards as well as to the NPDB, no action from those boards was taken for the majority of physicians.
Of the nearly 6,000 physicians for whom no action was taken by their state board, more than 3,600 had either a penalty that lasted a year or two or a permanent one. A Federation of State Medical Board spokesperson responding in HealthLeaders coverage LINK TO http://www.healthleadersmedia.com/content/COM-263817/55-of-Censured-Docs-Face-No-Licensing-Action-by-State-Medical-Boards to the report said that board investigations may be ongoing for those physicians, or that board actions may have been taken but could be confidential.
How are physicians using Twitter?
AN ANALYSIS OF TWITTER POSTS written by 260 physicians who each had 500 or more followers found that a small percentage of their tweets “3% ” were considered "unprofessional." Offensive tweets included potential violations of patient privacy, profanity, discriminatory remarks or material that was sexually explicit.
Researchers from the George Washington University Medical Center also found that an additional 1% of those physicians’ Twitter messages contained unsupported claims about products that the doctors were selling themselves, or other promotional material. Among physicians broadcasting messages that were considered unprofessional, the vast majority “92% “could be identified by their name and/or photograph.
Within the entire body of physicians’ Twitter feeds, 49% of tweets were related to health care or medicine, while 21% of messages were personal. The authors concluded that physicians may benefit from guidelines on how to use social media.
The data were part of a research letter published in the Feb. 9 Journal of the American Medical Association.