Published in the May 2004 issue of Today’s Hospitalist
AHRQ releases handheld version of pneumonia severity index calculator
The Agency for Healthcare Research and Quality (AHRQ) has released a handheld version of its pneumonia severity index calculator. The tool can help physicians determine whether newly diagnosed cases of community-acquired pneumonia can be safely treated on an outpatient basis.
The Pneumonia Severity Index Calculator is based on a clinical algorithm created in 1997 by a research team funded by the agency. The pneumonia patient outcomes research team, or PORT, developed and tested the algorithm.
In a randomized controlled trial, the algorithm was shown to be safe and cost-effective. It also improved patient satisfaction levels by allowing some patients to receive treatment at home.
The tool stratifies patients into risk categories based on their medical history, physical examination findings, and a limited set of lab and radiographic results. The model also predicts other important medical outcomes, including length of hospitalization, admission to an ICU for respiratory failure or hemodynamic compromise, and time to usual activities.
The agency says that a sizable number of low-risk patients can be treated safely in the outpatient setting, but they must be screened for appropriateness. Community-acquired pneumonia contracted outside the hospital affects nearly 4 million Americans a year and costs about $10 billion to treat. Ninety-two percent of those costs are spent on treating patients in the hospital.
The tool is available for Palm and Pocket PC based devices. An HTML version is also available.
You can download the software online. It is the AHRQ’s first decision-support tool for handheld computers.
A leveling trend: jury awards in medical malpractice cases
After more than doubling in the late 1990s, median jury awards in medical malpractice cases leveled off in the early part of the decade. The average award now comes in at just over $1 million. The percentage of awards totaling $1 million and above has also remained steady, at 52%.
Here are the median awards from 1996 through 2002 as reported by Jury Verdict Research:
With Medicare, higher spending doesn’t equal better care
New research has found that states with higher levels of Medicare spending often provide less effective care. Researchers attributed those differences at least in part to the mix of generalists and specialists.
The study, which was recently published on the Health Affairs Web site, says higher spending states tend to devote significant money to intensive care instead of more basic “and more effective “treatments.
Researchers from Dartmouth College say that health care spending itself is not the cause of lower quality care, but a symptom of a particular type of health care system. States with higher numbers of generalists, for example, tend to have lower overall spending and better outcomes.
New Hampshire, which spends about $5,000 per Medicare beneficiary, scored the highest overall quality ranking. Louisiana, which spent $8,000 per person, scored the lowest.
Increasing the number of generalists in a state by one per 10,000 people, the researchers found, was associated with a rise in the state’s quality ranking. It was also associated with a reduction in spending of nearly $700 per beneficiary.
Increasing the presence of specialists by that same ratio, on the other hand, led to a drop in overall quality and a spending increase of $526 per beneficiary.
The study, “Are spending and quality linked?”, is online.
Clause in bill may derail lawsuit against the Match
A lawsuit claiming the Match violates antitrust laws has suffered a setback in the form of a pension bill passed by Congress.
The pension legislation, which President Bush signed in early April, contained a provision exempting teaching hospitals from antitrust law. That could effectively remove teaching hospitals from a lawsuit led by three former medical residents.
The lawsuit charges that the Match effectively allows hospitals to join forces to prevent residents from negotiating higher pay, better hours and improved working conditions.
A federal judge had earlier this year allowed the case to proceed after removing some of the defendants. The plaintiffs were seeking class-action status.
According to a report in the Washington Post, the pension bill was amended at the behest of Sens. Edward Kennedy (D-Mass.) and Judd Gregg (R-N.H.). An aide to Sen. Kennedy was quoted in that report as saying that the legislator supported the Match and thought it met the needs of both teaching hospitals and medical students.
The provision received wide support from both Democrats and Republicans.