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VHIG Digest: Vol. 3, No. 3

This Week’s Top 3 Stories in Patient Safety and Quality Improvement in Healthcare

By Kate Gurba, School of Medicine, Class of 2014

1. Aggressive medical therapy is superior to stenting for treatment of intracranial arterial stenosis – 9/7/11

Fifty institutions participated in a randomized clinical trial to determine optimal treatment for preventing additional strokes in high-risk stroke patients, defined as those who had a recent TIA or stroke and severe stenosis (70-99%) of a major intracranial artery.  The study compared percutaneous transluminal angioplasty and stenting (PTAS) to “aggressive medical management” (aspirin, clopidogrel, and management of primary and secondary risk factors with lifestyle modification).  Aggressive medical management proved superior due to high rates of periprocedural stroke in the PTAS group.  Although monitoring continues, patient enrollment was terminated for ethical reasons in April 2011.

http://www.nejm.org/doi/full/10.1056/NEJMoa1105335

2. Health care reform did not affect ED usage in Massachusetts compared to regional trends – 9/7/11

Both increases and decreases in emergency department usage have been predicted to occur after an increase in the insured population (i.e., after Massachusetts-style health care reform).  A recent study compared quarterly numbers of ED visits in Massachusetts, Vermont, and New Hampshire between January 2004 and December 2009.  Massachusetts implemented health care reform over the course of a year, from October 2006 through December 2007.  All three states experienced continuous upward trends of ED utilization throughout the study period, but trends did not differ among states. This was true both for total numbers of ED visits and numbers of ED visits resulting in hospital admission.

http://www.nejm.org/doi/full/10.1056/NEJMp1109273

3. U.S. health spending increases are primarily due to increases in cost per case and treated prevalence, not increased disease prevalence – 9/2011

In an effort to determine the primary causes of increased health spending, a recent study reviewed the clinical prevalence (number of people with a given disease), treated prevalence (clinical prevalence multiplied by fraction receiving treatment) and cost per case of multiple diseases between 1996 and 2006.  The authors conclude that, of increased per capita health care spending over that period, approximately three-fourths was due to cost per case and one-fourth was due to an increase in treated prevalence.  Thus, an increase in overall disease prevalence may not be a primary driver of increased health care costs.

http://www.ncbi.nlm.nih.gov/pubmed/21900655



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