Published in the May 2016 issue of Today’s Hospitalist
How many patients are eligible for thrombectomy?
LAST YEAR, the American Heart Association/American Stroke Association revised its guidelines on the use of endovascular therapy for patients with ischemic stroke, spelling out criteria—including large vessel occlusion—for patients who should receive such therapy in addition to tPA.
But how many stroke patients meet criteria for thrombectomy? According to a retrospective analysis by Australian researchers, that figure is around 7% if restrictive eligibility criteria are used. Using more permissive criteria, the percentage rose to 13%.
Researchers analyzed one year of data on patients in Adelaide, Australia, a city with a population of 1.2 million. Based on that analysis, the authors wrote, one 24/7 endovascular center in that city should suffice. They pointed out, however, that similar “drip-and-ship” protocols may not be feasible in less dense populations.
The authors noted that their analysis may help providers construct cost-benefit models for endovascular centers. Results were posted online in March by Stroke.
Life expectancy is linked to income, geography
A NEW STUDY reveals that how long you can expect to live in the U.S. has a lot to do with how much you earn.
Researchers analyzing 1999-2014 federal income tax and Social Security data found an association between higher income and greater longevity. Further, they found that life-expectancy differences across income groups are increasing over time.
Compared to those at the bottom 1% of income, men at the top 1% of income live nearly 15 years longer, while women live 10 years more. Results were posted online in April by the Journal of the American Medical Association.
While those with higher incomes across different metropolitan areas have similar longevity, that’s not the case for populations with lower incomes: Those with the lowest 5% in income across four cities exhibited a variation in average life expectancy of six years. Researchers pegged that variation to health behaviors, such as smoking, not to differences in health care access or factors related to physical environment.
HOSPITAL score helps predict
readmission risk
IN AN INTERNATIONAL, multi-center study, researchers have validated what they call the HOSPITAL score, which relies on seven patient variables to assess readmission risk. The study analyzed more than 117,000 medical patients discharged from nine large hospitals in four countries.
The variables that make up the score include hemoglobin, discharge from an oncology service, sodium level, procedure during the index admission, index type of admission (urgent), number of admissions within the last 12 months and length of stay. Among patients studied, 14.5% were readmitted within 30 days and 9.7% had a potentially avoidable 30-day readmission. The study was published in the April issue of JAMA Internal Medicine.
The authors wrote that the score can help determine which patients are at low, intermediate and high readmission risk, allowing hospitals to target intensive post-discharge interventions to high-risk patients.
In another study, researchers publishing online in February in the Journal of Hospital Medicine found that the LACE Index (length of stay, acuity, comorbidity and ED use) was also helpful in predicting 30-day readmissions.
Higher satisfaction scores? Better outcomes
AFTER ANALYZING 2015 Hospital Compare data for more than 3,000 hospitals, researchers have linked higher rankings in patient experience to better outcomes.
The research, which was published in the March issue of the Journal of Patient Experience, indicated that hospitals with higher ratings on a five-star scale had fewer complications, including fewer CLABSIs and postop DVTs, as well as lower 30-day readmission rates. The effect size was modest, with 12.1% of stroke patients at hospitals with five-star ratings being readmitted within 30 days vs. 14.3% of those patients treated at hospitals rated only one star for patient experience.
However, the associations found between hospitals’ number of stars for patient experience and multiple improved outcomes was statistically significant. “These results support,” the authors concluded, “the inclusion of patient experience data in the framework of how hospitals are paid for services.”
PCI: making the case for same-day discharge
A CONSENSUS STATEMENT issued on PCI patients in 2009 listed many exclusions for same-day discharge. But a new review now argues that the majority of those exceptions no longer apply and that more widespread adoption of same-day discharge for PCI patients would lower costs without increasing adverse events or complication rates.
Many PCI patients no longer need to be kept overnight, the authors write, because of advances in technique, technology and medications. They note, however, that one big barrier to same-day discharge is “physician inertia.”
A previous analysis found that the U.S. could save between $200 million and $500 million a year if half the patients receiving PCI were discharged the same day.
The authors did point out that an overnight observation stay may still be appropriate for PCI patients who don’t have social support at home. JAMA Cardiology published the review online in March.
CMS announces
new primary-care model
LAST MONTH, the Centers for Medicare and Medicaid Services announced a five-year initiative that could usher in a new model of primary care.
The model, known as Comprehensive Primary Care Plus, will have two tracks, each with different payments and requirements. Practices in either track must give patients 24/7 access, and both tracks will feature up-front payment incentives, which groups who don’t perform well may have to pay back.
Practices in Track 1 will be paid fee for service and will receive $15 per month per beneficiary for patient management. Those in Track 2 will provide more comprehensive services and receive a higher per-month payment, as well as a $100 care management fee for highly complex patients.
Medicare plans to launch the initiative in January 2017 in 20 states or regions and in up to 5,000 practices covering 25 million patients. Groups can apply between July15 and Sept. 1 to participate.
