Archive for June, 2009
Council, IOM outline comparative effectiveness research suggestions
Two key players in the world of healthcare issued their suggestions to the Department of Health and Human Services (HHS) for what they consider priorities for comparative effectiveness research. The Federal Coordinating Council for Comparative Effectiveness Research outlined which interventions and populations should receive part of the $400 million being made available to HHS for comparative effectiveness research as part of the American Recovery and Reinvestment Act (ARRA) on Monday. Similarly, the Institute of Medicine (IOM) offered its suggestions yesterday about national priorities to be addressed by comparative effectiveness research. The ARRA is making a total of $1.1 billion available for comparative effectiveness research to the Agency for Healthcare Research and Quality and the National Institutes of Health, in addition to HHS.
Comparative effectiveness research is a way for professionals in healthcare to weigh treatment options based on evidence showing which types of treatment excel in specific situations. Literature review, patient study, and analysis of existing practice are all part of comparative effectiveness research.
To read suggestions from the IOM, click here.
To read suggestions from the Federal Coordinating Council for Comparative Effectiveness Research, click here.
Do any of these priorities jump out to you? Will the money being earmarked for comparative effectiveness research have an effect on your daily jobs?
AHRQ releases “state snapshot” quality Web site
I saw this Wall Street Journal Health Blog posting about a resource from the Agency for Healthcare Research and Quality (AHRQ) that I thought readers of this blog might be interested in: State Snapshots. The AHRQ has culled data based on the 2008 National Healthcare Quality Report and broken that data down into state-specific information. Those interested in seeing how their own states stack up against the rest of the states in the country can do so by clicking here and finding specific states via the map of the country.
How does your state match up? Was it what you expected to see?
Penicillin and others in its family may be best for treating MRSA in children
A study published in the June Pediatrics has produced evidence that medications in the beta-lactum family, which includes Penicillin, are just as good at treating MRSA in children than other types of antibiotics that have been used, and may prevent further resistance to antibiotic treatment. The study, funded by the AHRQ, evaluated 2,096 children who had MRSA infections of the skin or soft tissue. Researchers tested the effectiveness of three types of antibiotic on treating the infection.
The researchers concluded that the beta-lactums were just as good as another type of antibiotic at treating the infection in children, and should be used as a first line of defense when treating in the future.
VA facilities continue to be scrutinized for patient safety errors
At a Senate panel yesterday, the director of Miami Veterans Affairs Health Care System defended her facility’s improved patient safety practices in the wake of a scandal involving improperly sterilized equipment that may have put patients at risk for contracting HIV and Hepatitis, reports The Miami Herald. The possible exposure happened more than two months ago (read this earlier blog post). Mary Berrocal, director of the facility, says that changes have been made. The patient safety officer now reports directly to her on a weekly basis, as one example.
However, the chairman of the Senate Veterans’ Affairs Committee, Senator Akaka of Hawaii, says that there is a level of disorganization within the VA that has not been fixed, and it is a larger issue that leadership needs to focus on. VA hospitals have been told that each will be visited by July 14 by unannounced surveyors who are checking to see whether proper sterilization techniques are being utilized.
NEHI to launch medication initiative for patients with chronic illnesses
The New England Healthcare Institute is launching an initiative to investigate the reasons that some patients with chronic illnesses do not adhere to their medication regimens, and ways to improve adherence to taking prescribed medications. The initiative comes at a time when many patients with chronic care specifically are struggling to pay for the medications necessary for prevention. Patients with chronic conditions are more prone to healthcare complications if they do not adhere to their strict medication regimens. NEHI estimates that one third to one half of all patients with a chronic illness do not adhere to their prescribed medication regimens.
Other reasons that patients don’t stick to what their doctors advise for taking medications include forgetfulness, medication side effects, a break from illness symptoms, and low health literacy. Additionally, chronic patients who do not adhere to their medication regimens cost the health system $177 billion each year.
NEHI is hoping to identify strategies to boost patients’ compliance with prescribed medication regimens by creatively packaging medications, incorporating automated reminders into patient care, and using new patient education techniques, among other plans.
Patient satisfaction on the rise at EDs across the country
A new report from Press Ganey shows that despite reports of overcrowding, patient satisfaction scores for emergency departments (ED) actually rose last year, and the average national time spent at EDs dropped by two minutes, to 4 hours, 3 minutes. The 2009 Emergency Department Pulse Report: Patient Perspectives on American Health Careanalyzed 1.4 million patient responses about their ED stays at more than 1,700 EDs throughout the country. The increase in patient satisfaction may be related to EDs better communicating wait times with patients.
In an article with HealthLeaders Media, the spokesperson for the American College of Emergency Physicians, Leigh Vinocur, MD, said that she’s not surprised to see the rise in patient satisfaction scores because patients are frustrated with their inability to see their primary care physician (PCP) in a timely manner, as well as the wait times associated with a PCP referring patients to any specialists or for further testing. Patients leave the ED having seen a doctor and for the most part, receiving any testing necessary.
Other points that came out of the report: Staff scheduling is important. Patients who visited the ED between 7 am and 3 pm report being more satisfied with their visit to the ED. This is probably because by the time it’s the afternoon, there are more patients who have arrived, and less staff members to take care of them. Also, patients take the comfort of the waiting room seriously—those who felt the waiting room was not comfortable did not rate their overall stay very well.
For more information about the report, visit www.improvemyer.com
ACGME cites Boston hospital’s surgeons for working too many hours
The Accreditation Council for Graduate Medical Education (ACGME) recently cited Massachusetts General Hospital for allowing some surgical residents to work more hours than is allowed by the ACGME, reports The Boston Globe. The ACGME, which sets the standards on how many hours residents can work, gave the hospital until August 15 to correct its workload issues and reset residents’ schedules. The hospital, which found out about the violations in April, has already fixed the problem, said hospital sources.
The citation gives voice to teaching hospitals around the country that have struggled to keep up with the standards set by the ACGME. Currently, the requirements are residents work no more than an 80 hour work week, with no less than 10 hour breaks between shifts. The Institute of Medicine is recommending that residents working any overnight shifts of 30 hours or longer be given time to nap.
The hours were instituted to keep patients safe, as it is thought that residents who are overtired will be more likely to cause a medical error. However, the work hour requirements have not shown conclusively that patients are any safer. Additionally, residents sometimes feel like they have to choose between ensuring the safety of a patient by staying with him or her during a procedure, even if it means working beyond the required time, and going home because that means they are following the rules.
To read the article, click here. Are other teaching hospitals struggling with these restrictions on hours that residents can work?
Patients will be able to view their doctors’ notes in trial study
Would you want your patients to be able to read the notes made about them in their own personal medical records? That question is up for debate as the idea of personal health records and electronic medical records opens up a chance for greater patient interactivity with their own medical records. Beth Israel Deaconess Medical Center in Boston, MA, is launching a pilot program with 100 of its physicians called “open notes,” reports The Boston Globe.
Open notes will allow 25,000 to 35,000 patients to view their medical records for one year. The study aims to find out if patients use this information for the better, perhaps allowing them to have a greater understanding of what their doctors expect out of treatment, and what their doctors were actually thinking during a consultation. Some physicians feel this openness will lead to a poorer relationship with patients. Although the notes in a patient’s medical record are about that patient, often the notes are part of the medical assessment that the physician did not expect to share with the patient. Some doctors fear that they won’t be as candid with their notes for fear that patients will interpret their medical opinion as their own personal opinion. Additionally, some physicians fear that they will be hit with a barrage of e-mails asking for clarification of the notes.
To read more opinions on the topic, click here to read the full article.
How would you feel about your patients reading the notes in their medical records?
AMA votes to change white coat dress code
More infection control news this week:
As we mentioned last week on the Patient Safety Monitor Blog, the member of the American Medical Association did vote to move forward with a ban on physicians wearing white coats, in the name of infection prevention, reports The Wall Street Journal Health Blog. Earlier this week the group decided that it would advocate for hospitals to decide on a dress code that would minimize the spread of nosocomial infections, especially in ICUs and critical care units.
What do you think? Will physicians give up the status and reputation associated with the white coat in the name of infection control? I have a hunch they will.
But we don’t want to imagine a world without nurses!
If you haven’t seen this new TV ad from the California Nurses Association/National Nurses Organizing Committee (CNA/NNOC), United American Nurses (UAN) and Massachusetts Nurses Association (MNA), check it out–it’s a jarring reminder of how vital nurses are to quality patient care every day. It asks viewers to “Imagine a world without nurses.” The ad was produced in an effort to build support for standards that mandate adequate nurse staffing levels.
Recently, new legislation was introduced to set minimum standards for nurse staffing ratios, as well as emphasize the need for increased resources for nurse training and empower nurses to advocate on behalf of their patients.
For the full text of the proposed legislation, click here.
