VHIG Digest: Volume 1, No. 3
By Piotr Pilarski, VMS IV
In the News
1. New CMS Rule Requires Hospitals to Respect Visitation and Medical Decision-Making Rights of Same-Sex Couples – 11/18/10
With approximately 7,600 “overwhelmingly favorable” comments from various health care constituents and unanimous support from hospital groups, the Centers for Medicare and Medicaid Services (CMS) passed a rule that will require hospitals participating in Medicare and Medicaid to grant visiting rights to gay and lesbian partners and allow them to make medical decisions regarding their partner’s care. The rule follows reports of hospitals denying some patients visits from their same-sex partners and adopted children.
Source: Reichard, CQ HealthBeat[subscription required], 11/17; HHS release, 11/17.
2. New CMS Administrator—and Former IHI CEO—Defends Health Reform Law at First Congressional Hearing – 11/18/10
In his first congressional hearing since his controversial recess appointment in July 2010, CMS Administrator—and former Institute for Healthcare Improvement (IHI) President and CEO—Don Berwick, MD, MPP, told the Senate Finance Committee that the federal health reform law will improve Medicare and other health services. According to Berwick, provisions in the reform law strengthen funding for preventive services and allow CMS to experiment with more efficient and coordinated care. Berwick added that the health reform law should not be dismantled by Republicans, stating, “It is the best opportunity I think we’ve had in a generation” to improve the United States health care system.
Source: Stephenson, Reuters, 11/17; McCarthy, National Journal Daily, 11/17; Pear, Times, 11/17 [registration required]; Ethridge, CQ Today, 11/17 [subscription required]; Alonso-Zaldivar, AP/Washington Post, 11/17.
3. Early Results from NLST Show that Annual CT Scans of Current and Former Smokers May Reduce Lung Cancer Mortality by 20% – 11/05/10
According to a new National Cancer Institute (NCI) study known as the National Lung Screening Trial (NLST), annual computed tomography (CT) scans of current and former smokers may reduce their lung cancer mortality risk by 20%, a result so significant that researchers ended the study early. Preliminary results also showed that patients in the CT scan group had a 7% lower all-cause mortality rate. Until now, no study had shown that annual screenings could effectively reduce lung cancer mortality rates. Researchers now are working to compile false alarm rates, determine whether the screenings could benefit a broader smoker population and analyze the long-term health risks of radiation exposure from the CT scans.
Source: Harris, New York Times, 11/4 [registration required]; Fiore, MedPage Today, 11/4; AP/NPR, 11/4; Corbett Dooren, Wall Street Journal, 11/4 [subscription required].
4. AHRQ Report Finds 10% of 2008 Hospital Admissions Could Have Been Prevented – 11/04/10
A report by the Agency for Healthcare Research and Quality (AHRQ) found that one in ten hospitalizations in 2008 could have been avoided by preventing or better managing acute or chronic conditions. AHRQ researchers examined three chronic conditions (diabetes, circulatory conditions, and respiratory conditions) and three acute conditions (bacterial pneumonia, dehydration, and urinary tract infections). The report found that patients ages 65 and older had the most preventable hospital admissions (60%). Rural hospitals had twice the rate of preventable admissions among patients with acute conditions as urban hospitals—7% versus 3.4%. 15.9% of rural hospital stays were attributable to preventable chronic conditions, compared to 9.2% of urban hospital stays. The authors wrote that measuring the frequency of potentially preventable hospitalizations can help policymakers and providers identify communities that require enhanced outpatient care, which may include more comprehensive treatment and disease management programs.
Source: Clark, HealthLeaders Media, 11/4.
In the Literature
1. Temporal Trends in Rates of Patient Harm Resulting from Medical Care
A retrospective study of 2,341 admissions to 10 North Carolina hospitals from January 2002 to December 2007 found that harms from medical care remain common at a rate of 25.1 per 100 admissions. Over this period of time, there was little change in the overall rate of harms or in the rate of preventable harms, as identified by internal and external reviewers using the IHI’s Global Trigger Tool for Measuring Adverse Events. The authors concluded that despite extensive efforts to improve patient safety in the 10+ years since the publication of the Institute of Medicine’s report To Err Is Human, further efforts are needed to translate effective safety interventions into routine practice.
2. Automated External Defibrillators and Survival after In-Hospital Cardiac Arrest
A cohort study of 11,695 hospitalized patients with cardiac arrests at 204 U.S. hospitals between January 2000 and August 2008 found that the use of automated external defibrillators (AEDs) was associated with a lower rate of survival after in-hospital cardiac arrest compared with no AED use (16.3% vs 19.3%; adjusted rate ratio [RR], 0.85; 95% confidence interval [CI], 0.78-0.92; P < .001). AED use was associated with a lower survival among cardiac arrests due to nonshockable rhythms (10.4% vs 15.4%; adjusted RR, 0.74; 95% CI, 0.65-0.83; P < .001). For cardiac arrests due to shockable rhythms, AED use was not associated with increased survival (38.4% vs 39.8%; adjusted RR, 1.00; 95% CI, 0.88-1.13; P = .99). The authors concluded that while AEDs improve survival from out-of-hospital cardiac arrests, among hospitalized patients with cardiac arrest, use of AEDs was not associated with improved survival.
3. Effect of a Comprehensive Surgical Safety System on Patient Outcomes
A prospective study examining the effects on patient outcomes of a comprehensive, multidisciplinary surgical safety checklist implemented in six hospitals found that the total number of complications per 100 patients decreased from 27.3 (95% confidence interval [CI], 25.9 to 28.7) to 16.7 (95% CI, 15.6 to 17.9), for an absolute risk reduction of 10.6 (95% CI, 8.7 to 12.4). The proportion of patients with one or more complications decreased from 15.4% to 10.6% (P<0.001). In-hospital mortality decreased from 1.5% (95% CI, 1.2 to 2.0) to 0.8% (95% CI, 0.6 to 1.1), for an absolute risk reduction of 0.7 percentage points (95% CI, 0.2 to 1.2). Outcomes did not change in the control hospitals. The authors concluded that implementation of this comprehensive checklist was associated with a reduction in surgical complications and mortality in hospitals with a high standard of care.
4. Association Between Weekend Hospital Presentation and Stroke Fatality
A prospective study of 20,657 consecutive patients with acute stroke or TIA seen in the emergency department or admitted to the hospital at 11 stroke centers in Ontario, Canada, between July 1, 2003, and March 30, 2008 found that stroke care, including admission to a stroke unit, neuroimaging, and dysphagia screening, was similar in those treated on weekends and weekdays. However, all-cause 7-day fatality rates were higher in patients seen on weekends compared to weekdays (8.1% vs 7.0%), even after adjustment for age, sex, stroke severity, and comorbid conditions (adjusted hazard ratio 1.12, 95% confidence interval 1.00 to 1.25). The authors concluded that stroke fatality is higher with weekend compared to weekday admission, even after adjustment for case mix.