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Hospitalists and heart failure outcomes

November 2013

Published in the November 2013 issue of Today’s Hospitalist

Hospitalists and HF outcomes

ONE OF THE LARGEST STUDIES to date to look at hospitalist care of heart failure patients suggests that these patients may benefit the most when jointly managed by both hospitalists and cardiologists.

The research, published in the October issue of JACC: Heart Failure, looked at 2005-08 data for more than 31,500 hospitalized Medicare patients with heart failure in more than 160 hospitals. Researchers also calculated the percentage of patients in each hospital who were attended by hospitalists.

The authors found that hospitalists didn’t deliver lower readmission rates and that every 10% increase in a hospital’s use of hospitalists was associated with a slight increase in mortality rates. But the study also found that greater use of cardiologists in hospitals didn’t improve heart failure mortality or readmission rates either.

However, hospitals that made greater use of both hospitalists and cardiologists had better adherence to heart failure-related performance measures, “suggesting a possible synergy,” the authors wrote, that might support the use of comanagement models.

Mismatch between VTE rates and hospital quality

DO HIGHER VTE RATES indicate poorer hospital quality? The answer is “no,” according to a study published in the Oct. 9 issue of the Journal of the American Medical Association.

Researchers analyzed 2010 data for nearly 1 million surgical discharges and data from the Hospital Compare database. They found that hospitals with higher VTE rates also had higher rates of VTE prophylaxis and VTE imaging, with VTE rates jumping significantly as hospitals’ rate of VTE imaging increased.

The results suggested that higher event rates indicate more vigilance on the part of hospitals to diagnose VTE. Authors noted that “measuring VTE rates may be flawed because of surveillance bias.”

Researchers pointed out that the results call into question the use of VTE outcomes as a quality measure that affects payments based on hospital performance. Using such a flawed measure, they wrote, penalizes those hospitals that more rigorously screen for VTE.

AMA discharges and possible interventions

A RETROSPECTIVE REVIEW OF PATIENTS leaving one academic center against medical advice (AMA) over the course of two years finds that while documentation of an impending AMA was present in 75% of those cases, only a minority of records included documented interventions such as discharge medications prescribed or follow-up plans.

The study, which was published online in September in the Journal of Hospital Medicine, found that documenting an impending AMA discharge increased the number of prescriptions that doctors wrote and the number of follow-up plans documented. Among patients for whom an impending AMA discharge was documented, 30.4% were prescribed medications vs. only 6.8% for patients whose imminent AMA was not noted in their chart.

The researchers also found that doctors documented patients’ mental status and health literacy only 25% of the time. While the study did not find an association between documented interventions and lower rates of readmissions or return ED visits, the authors wrote that the effectiveness of such interventions “may still warrant future prospective study.”

One in seven surgery patients bounces back

WHILE THE READMISSION RATE among surgery patients lags behind that of medical patients, a new analysis of Medicare data found that 13% of patients discharged after a surgical procedure will be readmitted within 30 days.

The authors came up with composite readmission rates for hospitals performing at least one of six major surgeries. While the median surgical readmission rate across all hospitals was 13%, the authors found lower readmission rates among hospitals with higher surgical volumes (12.8% for hospitals in the highest volume quartile vs. 16.5% for those in the lowest) and among those with the lowest surgical mortality rates (13.3% vs. 14.2%). The study was published in the Sept. 19 issue of the New England Journal of Medicine.

The study did not find any association between readmission rates and hospital performance on publicly reported surgical process measures. While many medical patients may be readmitted because of a lack of access to primary care or poor social support, the authors noted that readmissions for surgical patients are due more often to post-surgical complications.