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Racial gaps in readmission rates

March 2011

Published in the March 2011 issue of Today’s Hospitalist

Racial gaps appear in readmission rates

AN ANALYSIS OF MEDICARE ADMINISTRATIVE DATA found that black patients have higher readmission rates than whites, as do hospitals that serve a larger proportion of minority patients.

A study in the Feb. 16 issue of the Journal of the American Medical Association found that Medicare patients who were black and admitted for MI, heart failure or pneumonia ran a 13% greater risk of being readmitted within 30 days than whites.

Patients discharged from hospitals that serve more minorities ran an even higher risk: 23%. Among black patients with MI in hospitals that had larger minority populations, for instance, 24.6% were readmitted within 30 days compared to 23.3% of blacks with MI in non-minority-serving hospitals. That rate was 20.9% for whites in hospitals that didn’t serve larger minority populations.

While researchers couldn’t explain the racial gap, they suggested that minority patients may have a harder time accessing high-quality outpatient care, which would help them stay out of the hospital. The authors also pointed out that plans to penalize hospitals that have a higher number of preventable readmissions could disproportionately hurt hospitals that serve minorities.

Should tPA be approved for mild strokes?

PRELIMINARY RETROSPECTIVE DATA suggest that using tPA in patients who present with mild strokes could significantly prevent stroke-related deficits and reduce the high price of stroke disabilities.

Findings presented at last month’s American Stroke Association’s International Stroke Conference indicated that expanding the use of tPA to include patients with mild strokes could prevent as many as 2,000 disability cases a year “and save $200 million in disability-related costs. Currently, patients with mild strokes receive only supportive care. That’s because trials that established the effectiveness of tPA excluded patients with mild strokes.

Researchers reviewed charts of patients who presented with ischemic strokes in 16 hospitals in 2005. Of those who had mild strokes, 62% would have met clinical criteria for receiving tPA, except for stroke severity.

More than half the patients who have strokes every year have mild episodes. According to researchers, one-third of those patients are disabled after three months. Researchers also noted that a large-scale trial for patients with mild strokes is being developed.

Why do women physicians earn less?

A NEW ANALYSIS OF STARTING SALARIES found that women doctors leaving training in New York state earned nearly $17,000 less than their male colleagues. That gap has grown over the past 10 years, according to the authors of a study published in the February issue of Health Affairs.

In 1999, for instance, newly trained women physicians in that state earned 12.5% less than their male counterparts “a difference that in 2008 had grown to 17%. That gender gap, authors said, can’t be explained by "practice setting, work hours, or other characteristics."

While it’s generally assumed that women physicians earn less because more women choose primary care fields, the study found that women had lower starting salaries in practically all specialties. While the reason for the widening gap isn’t clear, one author suggested that more women may negotiate more flexible schedules “with less night call, for instance “and that such flexibility is reflected in lower pay.

The analysis of starting salaries found that women graduating in 2008 in New York had higher salaries than their male counterparts in only two specialties: gastroenterology and general surgery.

Revised A-Fib guidelines incorporate dabigatran

NEWLY UPDATED GUIDELINES spell out parameters for using the oral anticoagulant dabigatran in patients with nonvalvular atrial fibrillation.

The guidelines do not recommend switching patients off warfarin who have "excellent INR control," saying that those patients may have little to gain from the new therapy. The guidelines, which were issued by the American Heart Association and the American College of Cardiology, also say that dabigatran should not be used in patients whose creatinine clearance is less than15 mL/ min. For patients with a creatinine clearance of more than 30 mL/min, the approved dose is 150 mg twice daily.

When prescribing dabigatran, the guidelines claim, clinicians should make sure that patients can comply with twice-a-day dosing. The authors also say that cost may be an issue. The guidelines, which were posted online last month in Circulation, also note that dabigatran “which was approved by the FDA in October 2010 “is the first new oral anticoagulant therapy to become available in more than 50 years.

Think short sleeves cut down on bacteria? Think again

RESEARCHERS IN COLORADO SAY that wearing short-sleeved hospital uniforms does not reduce the number of bacteria that doctors carry around with them in the hospital. Even when newly-laundered short-sleeve uniforms were donned every day, they quickly become colonized with the same levels of bacteria, including MRSA, as long-sleeved white coats that doctors admitted were being washed infrequently.

In a study posted online by the Journal of Hospital Medicine, authors found that both short-sleeved uniforms and long-sleeved white coats became contaminated with similar amounts of MRSA and other bacteria after a day in the hospital. They also found that within three hours, newly-laundered short-sleeved uniforms had nearly 50% of the bacteria they collected over the course of an eight-hour shift.

The highest bacterial colony counts were found on the cuffs of the long-sleeved white coats and on the pockets of the uniforms with short sleeves.

Concerns about clinicians transmitting bacteria on clothing led the British Department of Health in 2007 to ban the use of long-sleeved white coats as well as shirts and blouses with long sleeves. Study authors, however, said that clinicians would have to change clothes several times a day to avoid wearing clothes contaminated with bacteria.

Hospitalists get their own rap anthem

A SAN FRANCISCO-AREA HOSPITALIST who uses the moniker ZDoggMD to create and post parody rap videos has given hospitalists their own rap anthem.

Performed to the tune of Jay-Z’s "Hard Knock Life," ZDoggMD’s "Hard Docs’ Life" delivers an outrageous take on hospital medicine, with verses that include: "See 20 patients a day but get paid squat/The radiologist just bought a yacht" and "I’m gonna be on call/Whether I’m on call or not" (http://zdoggmd.com).

It’s the latest entry in ZDoggMD’s rap-video library that includes such titles as "Dysentery: The Musical" and "Man in the Mirror," a satiric take on testicular self-exams.

In Silicon Valley where he practices, ZDoggMD’s identity is known to his colleagues, but he remains anonymous online so patients won’t be startled by his Web persona. In addition to posting rap videos, ZDoggMD maintains a blog. Last month, his Web site was voted 2010’s Best New Medical Weblog by medGadget, an Internet journal of emerging medical technologies.