The Daily Briefing

News for Health Care Executives

Consumer Reports: We'll help patients avoid unnecessary tests

Groups launch patient education initiative with informational brochures

April 23, 2012

Consumer Reports and the American College of Physicians (ACP) are partnering on an education initiative to help patients determine whether a medical test or procedure is necessary. 

The two organizations—which recently joined the “Choosing Wisely” campaign and helped identify 45 tests and procedures that may be unnecessary or overused—last week launched “High Value Care,” a patient education program.

“We feel very strongly that in many cases, patients are asking for tests or treatments that they see on an advertisement or a promotion,” says John Santa, director of Consumer Reports’ Health Ratings Center, adding, “We know from our surveys that consumers are fixed in their belief that more health care is better.”

Using brief brochures available in English and Spanish, the organizations advise patients on procedures to avoid because there is not sufficient proof that their benefits outweigh their risks and costs. The brochures are available on the ACP, Annals of Internal Medicine (AIM), and Consumer Reports websites.

The program’s first two brochures focus on back pain and diabetes. Each brochure contains ACP clinical practice recommendations published in AIM and a sidebar containing “Consumer Reports Advice” based on the magazine’s subscriber surveys.

For example, the diabetes brochure promotes generic metformin as a drug that is more effective than more expensive brand alternatives for diabetes management. It also recommends diet and exercise lifestyle changes and seeking advice from certified diabetes educators, endocrinologists, and dieticians.

"In these days of crisis in health care costs, the medical profession should take its ethical and professional responsibility to do what we can to reduce costs while not compromising care,” says ACP CEO Steven Weinberger (Carrns, “Bucks,” New York Times, 4/19; Gever, MedPage Today, 4/19; Knox, “Shots,” NPR, 4/19).

Medical school works to protect students from 'ethical erosion'

NYT’s Chen details the success of a Harvard-based program

April 23, 2012

Many medical students can lose their sense of empathy during their third-year rotations—but one Harvard-based program may have successfully reinvented its curriculum to prevent "ethical erosion."

Writing last week in the New York Times, surgeon and author Pauline Chen explains how the rotations—"a speed-dating introduction to the major disciplines of medicine and the issues patients face"—often make students less empathetic toward their patients. She notes that many third-year students begin to refer to patients by their diseases rather than as individuals.

Various educators have worked to recreate the third-year curriculum to avoid this "ethical erosion," Chen writes. 

Possible model: Caring for a set group of patients
A recent Academic Medicine article detailed the success of a Harvard Medical School-Cambridge Integrated Clerkship that assigns third-year students to a panel of as many as100 patients; the students then provide continuous care to their assigned patients in Cambridge Health Alliance clinics. Students also are charged with providing outside consultations, care during hospitalizations, and home visits.

"Our goal was to use the students’ idealism and altruism as a frame for their learning and mastery of the science," says program director David Hirsh.

Since the program's launch in 2004, its students have performed better on tests assessing a physician’s ability to involve patients and family members in decision making, as well as ethics tests. Moreover, program graduates said they feel better prepared for clinical practice and tended to receive more guidance from senior physicians because they interact with them for a full year, rather than for one- or two-month rotations.

In addition, Hirsh found that patients enjoyed having a medical student assigned to them for a year. “Patients have gone on to tell their friends about the program,” he says, adding, “Now we are having difficulty keeping up with [patients' requests'] for their own medical students.”

Hirsh says the program is part of a “growing movement” to rethink medical education, and Chen adds that schools nationwide are strengthening or launching similar programs (Chen, “Well,” New York Times, 4/19).

Cancer patients stay mum on treatment problems

Study underscores need to improve doctor-patient communication

April 23, 2012

Many cancer patients who had issues with their treatment said nothing to the physician they felt was responsible and rarely reported the problem to hospital administration, according to a new study in the Journal of Clinical Oncology.

The survey of 400 cancer breast and colon cancer patients found that more than one in five thought something "went wrong" during the course of their treatment that could have been averted. Interviews with 78 patients—the majority of whom were women treated for breast cancer—also revealed that:

  • 75% cited communication problems with their provider, such as not receiving enough information or being provided with inaccurate information about their diagnosis;
  • 50% said an error occurred during the medical care itself, including surgical problems, infections, or perceived delays in care;
  • Nearly all felt that their issues with their doctor had caused psychological harm, while a majority said it resulted in pain and the need for additional treatment; and
  • Many also cited financial costs and life disruptions such as missed work.

Despite the numerous issues identified, the survey revealed that just one-third of the respondents had reported the event with the doctor or nurse responsible for their care, and only 10 patients formally notified hospital administration of the error.

According to the study's lead author Kathleen Mazor, from the Meyes Primary Care Institute and the University of Massachusetts Medical School, the survey underscores the need for patients to "speak up" about their treatment concerns. She also noted that hospitals should more clearly convey to patients where they can go if an issue arises.

Doctors should also strive to speak more with their patients and encourage them to be more open, according to Jeffrey Peppercorn of Duke University Medical Center, who wrote a commentary that accompanied the study. "We need to more generally improve communication with patients about their experience over the course of care," he wrote (Pittman, Reuters, 4/18).

Long-term pollution exposure may cause more hospitalizations

Study links pollutant to increase in chronic disease admissions

April 23, 2012

Older adults may face an increased risk of hospitalization for heart and lung disease, stroke, and diabetes as a result of long-term exposure to air pollution, according to a study in PLoS One.

For the study, researchers from the Harvard School of Public Health compared air quality data with hospital admission records for Medicare patients at 3000 hospitals across New England between 2002 and 2006. Specifically, they examined concentration levels of PM2.5, an air particle less than 2.5 microns in diameter that can settle in the lungs and cause inflammation. PM2.5 is emitted by vehicles, power plants, wood burning, and some industrial processes.

Results indicated that an increase of 10 micrograms per cubic meter of long-term PM2.5 exposure led to jumps in hospital admissions for diabetes, respiratory issues, strokes, and cardiovascular disease ranging in size from 3-6%. According to lead author Itai Kloog, “Our study found that long-term rates of admissions for pneumonia, heart attacks, strokes and diabetes are higher in locations with higher long-term average particle concentrations."

Senior author Joel Schwartz said, “Off-the-shelf technology can be retrofitted onto sources of pollution at modest cost, with a large health benefit. This study shows that in addition to avoiding deaths, such measures will reduce chronic disease and medical care costs” (Preidt, HealthDay, 4/18).

AHRQ finds little progress on access, care quality gaps

Agency finds quality improvements across most acute care measures

April 23, 2012

A recent Agency for Healthcare Research and Quality (AHRQ) report found that U.S. health disparities in care quality and access did not improve from 2002 to 2008.  

AHRQ tracks a number of measures to determine ethnic, racial, and income-related health care disparities in quality and access to care. For example, the agency monitors the percentage of racial and ethnic groups who are uninsured for an entire year and who report skipping or delaying care for financial reasons.

The report found no progress between 2002 and 2008 on about 50% of the disparity measures, while 40% of the measures showed an increase in disparities.

Specfically, the report found that:

  • More than 60% of access measures showed that Alaska natives, American Indians, and Hispanics experience worse access to care than whites;
  • Blacks experienced worse access to care than whites in slightly more than 40% of the measures; and
  • Asian-Americans experienced worse access than whites in 17% of the measures.

According to the report, "Urgent attention is warranted to ensure continued improvements in quality and progress on reducing disparities with respect to certain services, geographic areas, and populations."

Quality improves in some areas, disparities remain
Meanwhile, a second AHRQ report found that the United States made only slow improvement in care quality during the same time frame.

Altogether, the report found improvement in 77% of the performance measures related to acute care. However, it found improvement in only about half of the quality measures related to preventive care and chronic disease management.

In addition, the report found disparities in the quality of care among different racial and ethnic groups. Specifically:

  • In 41% of quality measures, blacks received worse care than whites; 
  • Low-income individuals received worse care than high-income individuals in 47% of quality measures; and
  • Adults ages 65 and older received worse care than adults ages 18 to 44 in 39% of quality measures (Reichard, CQ HealthBeat, 4/20 [subscription required]).

Weekly review

Key articles from April 16-April 20

April 23, 2012

Missed a day of the Daily Briefing? Here's a quick roundup of top stories and research highlights from last week’s issues.

The Advisory Board congratulates members named to '100 Top Hospitals' list (April 17)

Thomson Reuters last week named its annual "100 Top Hospitals" list, which is intended to recognize facilities that deliver higher quality and more efficient care than other hospitals of similar size or teaching status. The Advisory Board congratulates the 88 member hospitals named to Thomson Reuters' annual list of "100 Top Hospitals."

What will cost you more: Obesity or smoking? Mayo Clinic says obesity (April 18)

Both obesity and smoking contribute to higher individual health costs, but obesity brings more additional spending, according to a new study by Mayo Clinic researchers.

After the tornado: Joplin gets ‘remarkable’ replacement hospital (April 16)

Residents of a small Missouri town—devastated by a tornado last year, which killed 161 people and destroyed St. John's Regional Medical Center—are getting a special factory-built replacement hospital.

Why are women less satisfied with hospital care than men? (April 15)

Men and women have very different perceptions of their hospital experiences, Dr. Pauline Chen writes in the New York Times, which may complicate quality improvement and patient satisfaction efforts.

CDC: Hospital infections mostly down, but two states are outliers (April 20)

For the first time, CDC has issued state-by-state breakdowns of central line-associated bloodstream infections, finding that only hospitals in Arizona and Delaware saw a significant increase in infections.

Will apologies prevent lawsuits? Mass. hospitals pledge to find out (April 19)

Seven Massachusetts hospitals will offer prompt apologies and financial settlements to patients harmed by medical errors as part of a statewide initiative to improve the state's medical malpractice system.

CDC: Hospital infections mostly down, but two states are outliers

HHS releases 9-point HAI-reduction plan

April 20, 2012

For the first time, CDC has issued state-by-state breakdowns of central line-associated bloodstream infections (CLABSIs), finding that only hospitals in Arizona and Delaware saw a significant increase in infections.

CDC report: CLABSI rates dropped by 32% in 2010 
The report—which analyzed National Healthcare Safety Network data—found that:

  • CLABSI rates overall declined by 32%;
  • Surgical-site infection (SSI) rates declined by 8%; and
  • Catheter-associated urinary tract infection (UTI) rates dropped by 6%.

CDC's Scott Fridkin attributed the HAI reduction to national and state prevention efforts. According to MedPage Today, more than 20 states now mandate CLABSI and SSI reporting for all acute care hospitals and the number of hospitals reporting CLABSI data increased by 50% from 2009 to 2010.

"While our work must continue so that hospitals become even safer, this is clear evidence that care is improving," said American Hospital Association President and CEO Rich Umbdenstock.

The report found significant variation in states' infection control efforts and results. In response, CDC Director Thomas Frieden called for "a comprehensive approach for tackling infections in the nation's health care facilities, as patients can seek care from a variety of locations and move between health care facilities."

  • The Journey to Zero , one of the most popular studies in the Advisory Board's history, offers nine best practices to curb preventable infections.

HHS releases action plan to further reduce HAIs
HHS this week updated its action plan to reduce HAI rates.

The plan calls for another 50% reduction in CLABSIs and 25% reduction in UTIs and SSIs. It also aims for 100% adherence to central line insertion best practices, a 30% reduction in Clostridium difficile infections, and a 50% reduction in Methicillin-resistant Staphylococcus aureus infections.

According to Modern Healthcare, the action plan emphasizes the importance of health IT to effectively monitor HAIs.

The plan states, "Advances in IT, harmonization of disparate data standards, incentive programs designed to promote the meaningful use of electronic health records and capabilities to connect with and integrate multiple types and sources all provide opportunities to enhance national capacity to monitor, measure and prevent the occurrence of HAIs."

The plan will be published in the Federal Register next week and be available for public comment (Beasley, Reuters, 4/19; McKinney, Modern Physician, 4/19 [subscription required]; Walsh, MedPage Today, 4/19; CQ HealthBeat, 4/19 [subscription required]; McKinney, Modern Healthcare, 4/19 [subscription required]; AHA News, 4/19).

Daily roundup: April 23, 2012

Bite-sized hospital and health industry

April 23, 2012

  • California: Sutter Health hospitals have launched the "Having the Talk" campaign, in which palliative care teams at Sacramento-area hospitals encourage the health system’s employees to discuss end-of-life care plans with their families. Specifically, the program seeks to educate workers on the importance of talking to their families about end-of-life care preferences and finalizing the appropriate documents (Creamer, Sacramento Bee, 4/20).
  • Florida: Jackson Health System’s new chief strategy officer, Jeffrey Crudele, last week outlined details of the 94-year-old system’s strategic plan to its governing board. For example, he explained that the system plans to hire an additional 100 primary care physicians within the next three years. However, one commissioner has called for a more detailed plan and requested a closed-door meeting to discuss the system’s future next month. The commissioner said, “I want something tangible on new revenue streams” (Dorschner, Miami Herald, 4/19).
  • Illinois: Fitch Ratings last week warned that potential denial of property-tax exemptions for Illinois hospitals “is a negative credit development that could further strain financial performance” and “could negatively affect the ratings of Illinois not-for-profit hospitals.” The state Department of Revenue currently is considering the tax-exempt status of several hospitals across the state, although five hospitals withdrew their applications earlier this month to wait for a legislative solution (Frost, Chicago Tribune, 4/16).

  • Illinois: Gov. Pat Quinn (D) last week proposed a $2.7 billion plan to rein in Medicaid. The plan would cut $1.35 billion in annual Medicaid spending by reducing eligibility and coverage, slashing provider rates, cutting programs, and other changes. It also would raise additional revenue to fund Medicaid by increasing the cigarette tax by $1 per pack, thereby raising $335.7 million per year (Pierog, Reuters, 4/19).  

Learn strategies to instill frontline accountability

April 23, 2012

Join former CNO Joan Meadows as she shares the three-part framework to help nursing leaders build frontline accountability in their organizations. Learn more.


CDC: U.S. measles cases hit 15-year high

The number of diagnosed measles cases in the United States increased by 400% from 2010 to 2011 to reach a 15-year high of 222 cases, according to new data released by CDC.

The United States typically has about 60 measles cases per year.

According to CDC officials, most of the 2011 cases originated abroad, particularly in Europe where measles vaccination rates are considerably lower than in the United States. They noted that more than 37,000 measles cases were reported across Europe last year, many in countries frequented by U.S. tourists.

Although there were no measles deaths in the U.S. 2011, about 33% of the cases required hospitalization, according to a CDC official. The last measles-related death in the U.S. was reported in 2003.

So far in 2012, 27 measles cases have reported, but it is too early to determine whether the U.S. will see another increase, the AP/San Francisco Chronicle reports.

CDC officials call for increased immunizations

Although the number of measles cases originating in the United States is down, CDC officials say the government still must increase efforts to convince more U.S. residents to get their children vaccinated. Specifically, officials said that the government needs to focus on individuals with religious or philosophical reservations.

"Measles is preventable," says Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at CDC, adding, "Unvaccinated people put themselves and others at risk."

All but two states allow exemptions for religious reasons, while 20 allow for philosophical objections. Among the 222 reported cases in 2011, 86% were in individuals who were not vaccinated or were unsure they were, CDC said (McNeil, New York Times, 4/19; Beasley, Reuters, 4/19; Stobbe, AP/San Francisco Chronicle, 4/19; Norman, CQ HealthBeat, 4/19 [subscription required]).