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High mortality rates found for stroke patients

March 2010

Published in the March 2010 issue of Today’s Hospitalist

Mayo Arizona launches PA fellowship program

MEMBERS OF THE HOSPITAL MEDICINE DIVISION at Mayo Clinic in Phoenix published details of what they call the country’s first postgraduate physician assistant (PA) fellowship program in hospital medicine. Writing in the February issue of the Journal of Hospital Medicine, the authors said the program could be used as a model for other hospitalist groups needing to train non-physician providers.

Mayo Arizona launched the 12-month program in October 2007 to train one PA postgrad a year. The fellowship program consists of 12 one-month rotations of both clinical work and didactic training. The fellowship program was launched because the bulk of physician assistant training focuses on outpatient medicine, authors wrote, and experienced PAs tend to have a surgical or medical subspecialty background.

Another article in the same issue detailed the decision made by the University of Michigan hospitalist program to phase out its midlevel service. (See “Working with midlevels: a new note of caution.”) According to that article, the Michigan program had difficulty finding PAs and NPs with hospital medicine experience.

Children’s hospital develops free iPhone app

A FREE IPHONE APP developed by a pediatric children’s hospital in Texas offers information about common childhood conditions and helps families determine when children are having a medical emergency.

The KidsCheckUp application is a free download developed by Cook Children’s Health Care System in Fort Worth, Texas. Along with information about the health system, including locations, contact numbers and a virtual tour of the medical facility, the application gives signs and symptoms of 12 conditions.

It also features sections called “Is This an Emergency?” and “What Do I Do?”, as well as frequently asked medical questions and answers for parents.

Study finds high mortality among stroke patients

A STUDY THAT EXAMINED outcomes for more than 10,000 stroke patients concluded that 25% of those patients die within a year of any cause, and that 8% are likely to experience another stroke soon.

The findings, which appeared in the Feb. 16 issue of Neurology, looked at the outcomes of stroke patients in South Carolina during 2002. The state, along with the rest of the Southeast, is considered part of the “Stroke Belt” because it has an unusually high number of at-risk patients.

Researchers looked at events that patients experienced after discharge. Within four years, they concluded, 50% of stroke patients either died or had a heart attack or another stroke. African-Americans were found to have a 16% higher risk of stroke than whites, and every 10-year increase in age boosted heart attack risk by 14%.

Researchers wrote that the findings suggest the need for much more aggressive recurrent stroke prevention.

“Weak correlation” between discharge planning and readmissions

AS THE CENTERS FOR MEDICARE AND MEDICAID SERVICES searches for ways to reduce hospital readmission rates, a recent study has found only a weak correlation between two publicly-reported discharge measures and inpatient readmissions.

The study, published in the Dec. 31, 2009, New England Journal of Medicine (NEJM), looked at the correlation between readmission rates for heart failure and pneumonia and performance on two hospital measures: chart documentation that patients with heart failure were given discharge instructions, and patient-reported experiences about discharge planning.

There was no association between the chart-based measure and heart failure readmissions, and only “a very modest association” between performance on the patient-reported measure and readmission rates. The authors concluded that improving performance on current measures of discharge planning and efforts to publicly report those data were unlikely to reduce readmission rates.

Like previous studies, the NEJM study found wide variations in 30-day readmission rates. For heart failure, the lowest rates nationally were in Ogden, Utah, with 13.2%, while the highest were in Oxford, Miss., with 36.6%.