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Study on volume as a predictor of quality

Plus home-based hospice care, senior friendly site and chronic disease journal

February 2004

Published in the February 2004 issue of Today’s Hospitalist

Study raises questions about volume as a predictor of quality

A study has raised questions about the value of a hospital’s patient volume in predicting the outcomes of heart surgery.

Researchers from the Duke Clinical Research Institute found that a hospital’s volume of procedures was only “modestly associated” with death rates for CABG surgery. The study appeared in the Jan. 14 issue of the Journal of the American Medical Association.

After analyzing a group of 267,000 patients, researchers concluded that sending the patients to the highest-volume hospitals would have helped prevent the deaths of only 50 patients in 2000 and 2001. That would have been less than 1 percent of the 7,000-plus deaths that actually occurred in the group.

Researchers also found that hospitals that performed similar numbers of the procedure had a wide range of risk-adjusted mortality.

They concluded that deciding where to send patients based solely on volume would unfairly divert patients from nearly half of low-volume medical centers with the same or better mortality rates.

An abstract of the article is online.

Home-based hospice services may improve end-of-life care

The families of patients who died at home with hospice services rated the care of their loved ones more highly than the patients of families who died in hospitals, nursing homes or at home with home nursing services.

In a study in the Jan. 7 Journal of the American Medical Association, researchers talked to the family members of more than 1,500 patients who died in the year 2000. About two-thirds of patients in the study died in a hospital or nursing home; one-third died at home.

Family members of patients who died at home rated their loved one’s pain treatment significantly higher than the other groups. They also gave better marks to patient-caregiver communications.

Family members of patients who died in a nursing home or at home with home health nursing services “but not home hospice services “reported that their loved ones had more unmet needs for pain management compared to patients who had home hospice services.

More than two-thirds of the family members of patients who received home hospice services rated their loved one’s care as excellent. Less than half of the family members of patients who died in other settings, by comparison, gave a similar rating.

Researchers noted that not all results were influenced by setting. One-quarter of families reported concerns with physician communication during medical decision-making regardless of where the patient died.

An abstract of the study is online.

FDA posts materials on pain medications

As part of a larger campaign to reduce the misuse of over-the-counter pain medications, the FDA has posted information on its Web site to promote the safe use of pain relievers like acetaminophen.

The campaign, which includes public service announcements and patient brochures, is aimed at reducing accidental overdoses of acetaminophen and complications of using nonsteroidal anti-inflammatory drugs.

Materials from the FDA campaign note that patients who use pain relievers containing acetaminophen face a high risk of liver damage if they drink three or more alcoholic beverages a day. Patients also face a risk of stomach bleeding from NSAIDs if they are older than 60, use blood thinners or steroids, or have a history of stomach bleeding.

The Web materials include a Q&A, tips on how to properly use pain medications, and public service announcements. The materials are online.

Senior-friendly site offers “talking” feature

A new Web site from the National Institutes of Health (NIH) explains medical conditions for elderly Americans in a senior-friendly format, including a “talking” feature that can read text to users.

The site focuses on diseases of interest to seniors. Topics include Alzheimer’s disease and tips for caregivers, arthritis, balance problems, breast cancer, colorectal cancer, exercise for older adults, hearing loss, lung cancer and prostate cancer.

The Web site also features large print that is easy for older adults to read. Each topic provides background information, quizzes, a list of frequently asked questions, video clips, transcripts, and photos and illustrations with captions.

The site is online.

CDC launches online chronic disease journal

The CDC earlier this year launched a free, peer-reviewed online-only journal that focuses on chronic disease.

The January 2004 issue of Preventing Chronic Disease: Public Health Research, Practice and Policy features a video about tobacco control programs and research on flu and pneumonia vaccination rates for diabetics.

The journal says its goal is to “promote dialogue between researchers and practitioners on research findings and practical experience.”

The Web site is online.