Larry Beresford

Time, in hours, from recognition of stroke symptoms to computed tomography for hospitalized patients, compared with 1.3 hours for stroke patients brought to the ED, according to a study recently presented at the Canadian Stroke Congress.

The report estimates 17% of strokes occur among inpatients, but those patients wait longer for both neuroimaging and thrombolysis. Inpatients who experienced strokes also had longer hospital stays and higher mortality rates than patients brought to the ED. Researchers suggest that signs of stroke may be overlooked in patients who were admitted to the hospital for another reason, which is the main focus for their hospital caregivers, compared with stroke symptoms that occur in the community, where they may stand out more starkly.

Time, in hours, from recognition of stroke symptoms to computed tomography for hospitalized patients, compared with 1.3 hours for stroke patients brought to the ED, according to a study recently presented at the Canadian Stroke Congress.

The report estimates 17% of strokes occur among inpatients, but those patients wait longer for both neuroimaging and thrombolysis. Inpatients who experienced strokes also had longer hospital stays and higher mortality rates than patients brought to the ED. Researchers suggest that signs of stroke may be overlooked in patients who were admitted to the hospital for another reason, which is the main focus for their hospital caregivers, compared with stroke symptoms that occur in the community, where they may stand out more starkly.

Time, in hours, from recognition of stroke symptoms to computed tomography for hospitalized patients, compared with 1.3 hours for stroke patients brought to the ED, according to a study recently presented at the Canadian Stroke Congress.

The report estimates 17% of strokes occur among inpatients, but those patients wait longer for both neuroimaging and thrombolysis. Inpatients who experienced strokes also had longer hospital stays and higher mortality rates than patients brought to the ED. Researchers suggest that signs of stroke may be overlooked in patients who were admitted to the hospital for another reason, which is the main focus for their hospital caregivers, compared with stroke symptoms that occur in the community, where they may stand out more starkly.

New York’s Mount Sinai Hospital is among a growing number of healthcare systems nationwide providing patients with tablet computing devices.

Loaded with an HIPAA-compliant “patient itinerary” application designed by the hospital’s information technology (IT) department, the tablets give patients access to customized educational materials about their hospital stay. The program has been shown to ease communication between patients and caregivers, help patients to feel more engaged with their care, reduce patient stress, and improve staff workflow, according to a report in MHealthNews.

Mount Sinai’s inpatient care model redesign team—comprising both clinical and IT managers—deployed 100 tablets in the project’s pilot phase.

Meanwhile, a study from the United Kingdom reports that most patients don’t bring their own tablets to a hospital stay because “they are still unlikely to be able to connect to wifi when they get there,” according to a report in TheInformationDaily.com. Most of the country’s 2,300 hospitals fail to offer wireless access, and the access they do offer—bedside terminals with hotel-like charges for telephone, TV, video, and internet—mostly goes unused.

New York’s Mount Sinai Hospital is among a growing number of healthcare systems nationwide providing patients with tablet computing devices.

Loaded with an HIPAA-compliant “patient itinerary” application designed by the hospital’s information technology (IT) department, the tablets give patients access to customized educational materials about their hospital stay. The program has been shown to ease communication between patients and caregivers, help patients to feel more engaged with their care, reduce patient stress, and improve staff workflow, according to a report in MHealthNews.

Mount Sinai’s inpatient care model redesign team—comprising both clinical and IT managers—deployed 100 tablets in the project’s pilot phase.

Meanwhile, a study from the United Kingdom reports that most patients don’t bring their own tablets to a hospital stay because “they are still unlikely to be able to connect to wifi when they get there,” according to a report in TheInformationDaily.com. Most of the country’s 2,300 hospitals fail to offer wireless access, and the access they do offer—bedside terminals with hotel-like charges for telephone, TV, video, and internet—mostly goes unused.

New York’s Mount Sinai Hospital is among a growing number of healthcare systems nationwide providing patients with tablet computing devices.

Loaded with an HIPAA-compliant “patient itinerary” application designed by the hospital’s information technology (IT) department, the tablets give patients access to customized educational materials about their hospital stay. The program has been shown to ease communication between patients and caregivers, help patients to feel more engaged with their care, reduce patient stress, and improve staff workflow, according to a report in MHealthNews.

Mount Sinai’s inpatient care model redesign team—comprising both clinical and IT managers—deployed 100 tablets in the project’s pilot phase.

Meanwhile, a study from the United Kingdom reports that most patients don’t bring their own tablets to a hospital stay because “they are still unlikely to be able to connect to wifi when they get there,” according to a report in TheInformationDaily.com. Most of the country’s 2,300 hospitals fail to offer wireless access, and the access they do offer—bedside terminals with hotel-like charges for telephone, TV, video, and internet—mostly goes unused.

CMS started the third year of its Hospital Readmissions Reduction Program on October 1, with 2,610 U.S. hospitals—slightly more than in previous years—on the hook for penalties of up to 3% of their Medicare diagnosis-related grouping payments based on 30-day readmissions rates for diagnoses of myocardial infarction, heart failure, pneumonia, COPD, and elective total hip and total knee arthroplasty posted between July 2010 and June 2013.

According to analysis by Kaiser Health News, 39 hospitals will incur the maximum penalty, and hospitals collectively will pay an estimated $428 million in penalties in the current fiscal year for readmission rates deemed higher than expected by CMS formulas.

Medicare’s overall readmission rate in 2013 was 18%, which was down slightly from previous years but still amounted to two million patients. CMS estimates that these readmissions cost $26 billion, 65% of which was attributed to avoidable readmissions. CMS’ fiscal year 2015 final rule for reimbursement under the Hospital Inpatient Prospective Payment System, first published in the Federal Register, spells out fiscal year 2015 penalties and readmissions payment adjustment factors.

CMS started the third year of its Hospital Readmissions Reduction Program on October 1, with 2,610 U.S. hospitals—slightly more than in previous years—on the hook for penalties of up to 3% of their Medicare diagnosis-related grouping payments based on 30-day readmissions rates for diagnoses of myocardial infarction, heart failure, pneumonia, COPD, and elective total hip and total knee arthroplasty posted between July 2010 and June 2013.

According to analysis by Kaiser Health News, 39 hospitals will incur the maximum penalty, and hospitals collectively will pay an estimated $428 million in penalties in the current fiscal year for readmission rates deemed higher than expected by CMS formulas.

Medicare’s overall readmission rate in 2013 was 18%, which was down slightly from previous years but still amounted to two million patients. CMS estimates that these readmissions cost $26 billion, 65% of which was attributed to avoidable readmissions. CMS’ fiscal year 2015 final rule for reimbursement under the Hospital Inpatient Prospective Payment System, first published in the Federal Register, spells out fiscal year 2015 penalties and readmissions payment adjustment factors.

CMS started the third year of its Hospital Readmissions Reduction Program on October 1, with 2,610 U.S. hospitals—slightly more than in previous years—on the hook for penalties of up to 3% of their Medicare diagnosis-related grouping payments based on 30-day readmissions rates for diagnoses of myocardial infarction, heart failure, pneumonia, COPD, and elective total hip and total knee arthroplasty posted between July 2010 and June 2013.

According to analysis by Kaiser Health News, 39 hospitals will incur the maximum penalty, and hospitals collectively will pay an estimated $428 million in penalties in the current fiscal year for readmission rates deemed higher than expected by CMS formulas.

Medicare’s overall readmission rate in 2013 was 18%, which was down slightly from previous years but still amounted to two million patients. CMS estimates that these readmissions cost $26 billion, 65% of which was attributed to avoidable readmissions. CMS’ fiscal year 2015 final rule for reimbursement under the Hospital Inpatient Prospective Payment System, first published in the Federal Register, spells out fiscal year 2015 penalties and readmissions payment adjustment factors.

Antibiotic overprescription remains a problem in the U.S. and abroad and shows no signs of slowing. A study published in the October 2014 issue of JAMA reports that nearly half of all hospitalized patients receive antibiotics, and the drugs most commonly prescribed are broad-spectrum antibiotics, which have been linked with promoting the spread of antibiotic-resistant bacteria. Based on a one-day prevalence survey of more than 11,000 patients in 183 U.S. hospitals in 2011, the study notes that half of inpatients prescribed antibiotics received two or more of them. The CDC estimates that 20% to 50% of all antibiotics prescribed in U.S. hospitals are either unnecessary or inappropriate, and many of them count adverse drug reactions among their side effects .

While a growing body of evidence suggests that hospital-based antibiotic stewardship programs can optimize treatment, reduce antibacterial side effects, and save money, a study published September 2014 in JAMA says those benefits may be lost post-discharge. Results of a randomized trial of an outpatient antimicrobial stewardship intervention found that an initial 50% reduction in antibiotic prescriptions was lost when their targeted interventions ceased.

“These data suggest that audit and feedback was a vital element of this intervention and that antimicrobial stewardship requires continued, active efforts to sustain initial improvements,” says lead author Jeffrey S. Gerber, MD, PhD, CHCP, attending physician in infectious diseases at the Children’s Hospital of Philadelphia.

The federal government has taken a three-pronged approach to the problem: a report from the President’s Council of Advisors on Science and Technology with recommendations for monitoring superbugs and slowing their spread; an executive order issued by President Obama on September 18, 2014 with a commitment to “accelerate scientific research and facilitate the development of new antibacterial drugs;” and the creation of a national task force charged with designing a national strategy to combat antibiotic overuse by February 2015.

The President’s Council report notes that bacteria are becoming resistant to antibiotics in large part because these drugs are overprescribed to patients and overused in animals raised for food. The report recommends the CDC develop rules by 2017 requiring hospitals and nursing homes to implement best practices for antibiotic use.

Antibiotic overprescription remains a problem in the U.S. and abroad and shows no signs of slowing. A study published in the October 2014 issue of JAMA reports that nearly half of all hospitalized patients receive antibiotics, and the drugs most commonly prescribed are broad-spectrum antibiotics, which have been linked with promoting the spread of antibiotic-resistant bacteria. Based on a one-day prevalence survey of more than 11,000 patients in 183 U.S. hospitals in 2011, the study notes that half of inpatients prescribed antibiotics received two or more of them. The CDC estimates that 20% to 50% of all antibiotics prescribed in U.S. hospitals are either unnecessary or inappropriate, and many of them count adverse drug reactions among their side effects .

While a growing body of evidence suggests that hospital-based antibiotic stewardship programs can optimize treatment, reduce antibacterial side effects, and save money, a study published September 2014 in JAMA says those benefits may be lost post-discharge. Results of a randomized trial of an outpatient antimicrobial stewardship intervention found that an initial 50% reduction in antibiotic prescriptions was lost when their targeted interventions ceased.

“These data suggest that audit and feedback was a vital element of this intervention and that antimicrobial stewardship requires continued, active efforts to sustain initial improvements,” says lead author Jeffrey S. Gerber, MD, PhD, CHCP, attending physician in infectious diseases at the Children’s Hospital of Philadelphia.

The federal government has taken a three-pronged approach to the problem: a report from the President’s Council of Advisors on Science and Technology with recommendations for monitoring superbugs and slowing their spread; an executive order issued by President Obama on September 18, 2014 with a commitment to “accelerate scientific research and facilitate the development of new antibacterial drugs;” and the creation of a national task force charged with designing a national strategy to combat antibiotic overuse by February 2015.

The President’s Council report notes that bacteria are becoming resistant to antibiotics in large part because these drugs are overprescribed to patients and overused in animals raised for food. The report recommends the CDC develop rules by 2017 requiring hospitals and nursing homes to implement best practices for antibiotic use.

Antibiotic overprescription remains a problem in the U.S. and abroad and shows no signs of slowing. A study published in the October 2014 issue of JAMA reports that nearly half of all hospitalized patients receive antibiotics, and the drugs most commonly prescribed are broad-spectrum antibiotics, which have been linked with promoting the spread of antibiotic-resistant bacteria. Based on a one-day prevalence survey of more than 11,000 patients in 183 U.S. hospitals in 2011, the study notes that half of inpatients prescribed antibiotics received two or more of them. The CDC estimates that 20% to 50% of all antibiotics prescribed in U.S. hospitals are either unnecessary or inappropriate, and many of them count adverse drug reactions among their side effects .

While a growing body of evidence suggests that hospital-based antibiotic stewardship programs can optimize treatment, reduce antibacterial side effects, and save money, a study published September 2014 in JAMA says those benefits may be lost post-discharge. Results of a randomized trial of an outpatient antimicrobial stewardship intervention found that an initial 50% reduction in antibiotic prescriptions was lost when their targeted interventions ceased.

“These data suggest that audit and feedback was a vital element of this intervention and that antimicrobial stewardship requires continued, active efforts to sustain initial improvements,” says lead author Jeffrey S. Gerber, MD, PhD, CHCP, attending physician in infectious diseases at the Children’s Hospital of Philadelphia.

The federal government has taken a three-pronged approach to the problem: a report from the President’s Council of Advisors on Science and Technology with recommendations for monitoring superbugs and slowing their spread; an executive order issued by President Obama on September 18, 2014 with a commitment to “accelerate scientific research and facilitate the development of new antibacterial drugs;” and the creation of a national task force charged with designing a national strategy to combat antibiotic overuse by February 2015.

The President’s Council report notes that bacteria are becoming resistant to antibiotics in large part because these drugs are overprescribed to patients and overused in animals raised for food. The report recommends the CDC develop rules by 2017 requiring hospitals and nursing homes to implement best practices for antibiotic use.

Patients might come into a hospitalist’s care when they are in the middle of a clinical trial. What then?

The first step for a hospitalist is to find out whether a patient is enrolled in a trial.

“The safety and health of a patient obviously are more important than anything else,” Dr. Khuri says, “but simply asking about participation in a trial can avert doing something that unnecessarily forces the removal of the patient from the trial, in which they might have been receiving a beneficial treatment.

“What they [hospitalists] don’t want to do, unless they have to, is something that forces the patient to come off a clinical trial. Unfortunately, that’s a relatively easy thing to do.”

Hospitalists should ask their cancer patients if they are part of a cancer clinical trial. If the answer is yes, hospitalists “need to be very careful to obtain information about that trial, to understand if the trial is in any way contributing to the illness, or is it helping improve the acute illness,” Dr. Khuri says. Hospitalists also need to know if they are “going to do something that could potentially force the patient to be ineligible to continue that treatment.”

Treatments being explored in trials are often metabolized in the liver or excreted in the kidneys, and the hospitalist might have a choice between two treatment options—one of which might interfere with how the drug is metabolized and another that does not. The steps taken by hospitalists could determine whether the patient would have to be taken off treatment they were being given in the trial.

“If that treatment option on the clinical trial constitutes the best option for the patient, I don’t need to tell you that intervening in a way that forces the patient off that experimental treatment is undesirable in all but the most important, life-saving situations,” Dr. Khuri says.

But it all starts with asking the question.

“You couldn’t even process that information,” he says, “if you didn’t know in the first place that the patient was on a clinical trial.”

Patients might come into a hospitalist’s care when they are in the middle of a clinical trial. What then?

The first step for a hospitalist is to find out whether a patient is enrolled in a trial.

“The safety and health of a patient obviously are more important than anything else,” Dr. Khuri says, “but simply asking about participation in a trial can avert doing something that unnecessarily forces the removal of the patient from the trial, in which they might have been receiving a beneficial treatment.

“What they [hospitalists] don’t want to do, unless they have to, is something that forces the patient to come off a clinical trial. Unfortunately, that’s a relatively easy thing to do.”

Hospitalists should ask their cancer patients if they are part of a cancer clinical trial. If the answer is yes, hospitalists “need to be very careful to obtain information about that trial, to understand if the trial is in any way contributing to the illness, or is it helping improve the acute illness,” Dr. Khuri says. Hospitalists also need to know if they are “going to do something that could potentially force the patient to be ineligible to continue that treatment.”

Treatments being explored in trials are often metabolized in the liver or excreted in the kidneys, and the hospitalist might have a choice between two treatment options—one of which might interfere with how the drug is metabolized and another that does not. The steps taken by hospitalists could determine whether the patient would have to be taken off treatment they were being given in the trial.

“If that treatment option on the clinical trial constitutes the best option for the patient, I don’t need to tell you that intervening in a way that forces the patient off that experimental treatment is undesirable in all but the most important, life-saving situations,” Dr. Khuri says.

But it all starts with asking the question.

“You couldn’t even process that information,” he says, “if you didn’t know in the first place that the patient was on a clinical trial.”

Patients might come into a hospitalist’s care when they are in the middle of a clinical trial. What then?

The first step for a hospitalist is to find out whether a patient is enrolled in a trial.

“The safety and health of a patient obviously are more important than anything else,” Dr. Khuri says, “but simply asking about participation in a trial can avert doing something that unnecessarily forces the removal of the patient from the trial, in which they might have been receiving a beneficial treatment.

“What they [hospitalists] don’t want to do, unless they have to, is something that forces the patient to come off a clinical trial. Unfortunately, that’s a relatively easy thing to do.”

Hospitalists should ask their cancer patients if they are part of a cancer clinical trial. If the answer is yes, hospitalists “need to be very careful to obtain information about that trial, to understand if the trial is in any way contributing to the illness, or is it helping improve the acute illness,” Dr. Khuri says. Hospitalists also need to know if they are “going to do something that could potentially force the patient to be ineligible to continue that treatment.”

Treatments being explored in trials are often metabolized in the liver or excreted in the kidneys, and the hospitalist might have a choice between two treatment options—one of which might interfere with how the drug is metabolized and another that does not. The steps taken by hospitalists could determine whether the patient would have to be taken off treatment they were being given in the trial.

“If that treatment option on the clinical trial constitutes the best option for the patient, I don’t need to tell you that intervening in a way that forces the patient off that experimental treatment is undesirable in all but the most important, life-saving situations,” Dr. Khuri says.

But it all starts with asking the question.

“You couldn’t even process that information,” he says, “if you didn’t know in the first place that the patient was on a clinical trial.”

Engaging patients more effectively in their own treatment is becoming a growing focus for hospitals and hospitalists. The Wall Street Journal earlier this year described how hospitals are scoring patients on their “activation”—how engaged they are likely to be in their ongoing care and recovery—with measurement tools such as the Patient Activation Measure (www.insigniahealth.com/solutions/patient-activation-measure)—in order to customize their care through special coaching or other interventions.⁴ Information Week Healthcare notes that more hospitals are putting patient experience officers in the C-suite to help them learn how to treat patients more like valued customers.⁵

One of the country’s first chief experience officers (CXOs), James Merlino, MD, CXO for Cleveland Clinic, heads a department that hosts the annual Patient Experience Summit, which was held in Cleveland in May with co-sponsorship by the Society for Hospital Medicine and the American Hospital Association. It’s one thing to talk about how important patient experience is, Dr. Merlino told Information Week Healthcare. “But it’s another to hold people accountable for it.”

Larry Beresford is a freelance writer in Alameda, Calif.

References

1. Nagasako EM, Reidhead M, Waterman B, Dunagan WC. Adding socioeconomic data to hospital readmissions calculations may produce more useful results. Health Affair. 2014;33(5):786-791.
2. Hu J, Gonsahn MD, Nerenz DR. Socioeconomic status and readmissions: Evidence from an urban teaching hospital. Health Affair. 2014;33(5):778-785.
3. Hoyer EH, Needham DM, Atanelov L, Knox B, Friedman M, Brotman DJ. Association of impaired functional status at hospital discharge and subsequent rehospitalization. J Hosp Med. 2014;9(5):277–282.
4. Landro L. How doctors rate patients. The Wall Street Journal. March 31, 2014. Available at: http://online.wsj.com/news/articles/SB10001424052702304432604579473301109907412. Accessed July 31, 2014.
5. Diana A. Hospitals elevate patient satisfaction to the C-suite. Information Week Healthcare. March 24, 2014. Available at: http://www.informationweek.com/healthcare/leadership/ hospitals-elevate-patient-satisfaction-to-the-c-suite/d/d-id/1127860. Accessed July 31, 2014.
6. The Press Association. London trust now testing seriously ill patients for HIV. Nursing Times. May 8, 2014. Available at: http://www.nursingtimes.net/confirmation?rtn=%252fbarts-to-rollout-routine-hiv-testing-for-intensive-care-patients%252f5070642.article. Accessed July 31, 2014.
7. Pallin DJ, Espinola JA, Camargo CA Jr. US population aging and demand for inpatient services. J Hosp Med. 2014;9(3):193-196.

Engaging patients more effectively in their own treatment is becoming a growing focus for hospitals and hospitalists. The Wall Street Journal earlier this year described how hospitals are scoring patients on their “activation”—how engaged they are likely to be in their ongoing care and recovery—with measurement tools such as the Patient Activation Measure (www.insigniahealth.com/solutions/patient-activation-measure)—in order to customize their care through special coaching or other interventions.⁴ Information Week Healthcare notes that more hospitals are putting patient experience officers in the C-suite to help them learn how to treat patients more like valued customers.⁵

One of the country’s first chief experience officers (CXOs), James Merlino, MD, CXO for Cleveland Clinic, heads a department that hosts the annual Patient Experience Summit, which was held in Cleveland in May with co-sponsorship by the Society for Hospital Medicine and the American Hospital Association. It’s one thing to talk about how important patient experience is, Dr. Merlino told Information Week Healthcare. “But it’s another to hold people accountable for it.”

Larry Beresford is a freelance writer in Alameda, Calif.

References

1. Nagasako EM, Reidhead M, Waterman B, Dunagan WC. Adding socioeconomic data to hospital readmissions calculations may produce more useful results. Health Affair. 2014;33(5):786-791.
2. Hu J, Gonsahn MD, Nerenz DR. Socioeconomic status and readmissions: Evidence from an urban teaching hospital. Health Affair. 2014;33(5):778-785.
3. Hoyer EH, Needham DM, Atanelov L, Knox B, Friedman M, Brotman DJ. Association of impaired functional status at hospital discharge and subsequent rehospitalization. J Hosp Med. 2014;9(5):277–282.
4. Landro L. How doctors rate patients. The Wall Street Journal. March 31, 2014. Available at: http://online.wsj.com/news/articles/SB10001424052702304432604579473301109907412. Accessed July 31, 2014.
5. Diana A. Hospitals elevate patient satisfaction to the C-suite. Information Week Healthcare. March 24, 2014. Available at: http://www.informationweek.com/healthcare/leadership/ hospitals-elevate-patient-satisfaction-to-the-c-suite/d/d-id/1127860. Accessed July 31, 2014.
6. The Press Association. London trust now testing seriously ill patients for HIV. Nursing Times. May 8, 2014. Available at: http://www.nursingtimes.net/confirmation?rtn=%252fbarts-to-rollout-routine-hiv-testing-for-intensive-care-patients%252f5070642.article. Accessed July 31, 2014.
7. Pallin DJ, Espinola JA, Camargo CA Jr. US population aging and demand for inpatient services. J Hosp Med. 2014;9(3):193-196.

Engaging patients more effectively in their own treatment is becoming a growing focus for hospitals and hospitalists. The Wall Street Journal earlier this year described how hospitals are scoring patients on their “activation”—how engaged they are likely to be in their ongoing care and recovery—with measurement tools such as the Patient Activation Measure (www.insigniahealth.com/solutions/patient-activation-measure)—in order to customize their care through special coaching or other interventions.⁴ Information Week Healthcare notes that more hospitals are putting patient experience officers in the C-suite to help them learn how to treat patients more like valued customers.⁵

One of the country’s first chief experience officers (CXOs), James Merlino, MD, CXO for Cleveland Clinic, heads a department that hosts the annual Patient Experience Summit, which was held in Cleveland in May with co-sponsorship by the Society for Hospital Medicine and the American Hospital Association. It’s one thing to talk about how important patient experience is, Dr. Merlino told Information Week Healthcare. “But it’s another to hold people accountable for it.”

Larry Beresford is a freelance writer in Alameda, Calif.

References

1. Nagasako EM, Reidhead M, Waterman B, Dunagan WC. Adding socioeconomic data to hospital readmissions calculations may produce more useful results. Health Affair. 2014;33(5):786-791.
2. Hu J, Gonsahn MD, Nerenz DR. Socioeconomic status and readmissions: Evidence from an urban teaching hospital. Health Affair. 2014;33(5):778-785.
3. Hoyer EH, Needham DM, Atanelov L, Knox B, Friedman M, Brotman DJ. Association of impaired functional status at hospital discharge and subsequent rehospitalization. J Hosp Med. 2014;9(5):277–282.
4. Landro L. How doctors rate patients. The Wall Street Journal. March 31, 2014. Available at: http://online.wsj.com/news/articles/SB10001424052702304432604579473301109907412. Accessed July 31, 2014.
5. Diana A. Hospitals elevate patient satisfaction to the C-suite. Information Week Healthcare. March 24, 2014. Available at: http://www.informationweek.com/healthcare/leadership/ hospitals-elevate-patient-satisfaction-to-the-c-suite/d/d-id/1127860. Accessed July 31, 2014.
6. The Press Association. London trust now testing seriously ill patients for HIV. Nursing Times. May 8, 2014. Available at: http://www.nursingtimes.net/confirmation?rtn=%252fbarts-to-rollout-routine-hiv-testing-for-intensive-care-patients%252f5070642.article. Accessed July 31, 2014.
7. Pallin DJ, Espinola JA, Camargo CA Jr. US population aging and demand for inpatient services. J Hosp Med. 2014;9(3):193-196.

Following a successful pilot at The Royal London Hospital in Whitechapel, the Barts Health NHS Trust of the British National Health Service has begun routinely offering the blood test for HIV infection to all critical care patients served by the trust, aiming to get more HIV cases diagnosed earlier, thereby helping to stop the virus’ spread by those who don’t know they are infected. Fifty-two percent of 899 patients on the pilot critical care unit agreed to the test, three of whom tested positive for HIV, enabling their doctors to commence treatment.⁶

Patients on critical care units are receiving blood tests already, and the HIV test was presented as just one more test, albeit one with the potential to save lives and stop HIV transmission to partners, said Barts Health NHS Trust HIV medicine consultant Chloe Orkin, MD.

“People are still dying of HIV in the UK—but only because they test too late,” Dr. Orkin says.

The new policy at the UK’s largest regional health trust is in line with guidelines recommending the introduction of universal opt-out testing for HIV in critical care departments where local prevalence of the infection exceeds two per 1,000 individuals.

Larry Beresford is a freelance writer in Alameda, Calif.

Following a successful pilot at The Royal London Hospital in Whitechapel, the Barts Health NHS Trust of the British National Health Service has begun routinely offering the blood test for HIV infection to all critical care patients served by the trust, aiming to get more HIV cases diagnosed earlier, thereby helping to stop the virus’ spread by those who don’t know they are infected. Fifty-two percent of 899 patients on the pilot critical care unit agreed to the test, three of whom tested positive for HIV, enabling their doctors to commence treatment.⁶

Patients on critical care units are receiving blood tests already, and the HIV test was presented as just one more test, albeit one with the potential to save lives and stop HIV transmission to partners, said Barts Health NHS Trust HIV medicine consultant Chloe Orkin, MD.

“People are still dying of HIV in the UK—but only because they test too late,” Dr. Orkin says.

The new policy at the UK’s largest regional health trust is in line with guidelines recommending the introduction of universal opt-out testing for HIV in critical care departments where local prevalence of the infection exceeds two per 1,000 individuals.

Larry Beresford is a freelance writer in Alameda, Calif.

Following a successful pilot at The Royal London Hospital in Whitechapel, the Barts Health NHS Trust of the British National Health Service has begun routinely offering the blood test for HIV infection to all critical care patients served by the trust, aiming to get more HIV cases diagnosed earlier, thereby helping to stop the virus’ spread by those who don’t know they are infected. Fifty-two percent of 899 patients on the pilot critical care unit agreed to the test, three of whom tested positive for HIV, enabling their doctors to commence treatment.⁶

Patients on critical care units are receiving blood tests already, and the HIV test was presented as just one more test, albeit one with the potential to save lives and stop HIV transmission to partners, said Barts Health NHS Trust HIV medicine consultant Chloe Orkin, MD.

“People are still dying of HIV in the UK—but only because they test too late,” Dr. Orkin says.

The new policy at the UK’s largest regional health trust is in line with guidelines recommending the introduction of universal opt-out testing for HIV in critical care departments where local prevalence of the infection exceeds two per 1,000 individuals.

Larry Beresford is a freelance writer in Alameda, Calif.

72%

Total growth in hospital capacity needed by the year 2050, according to an analysis in the Journal of Hospital Medicine.⁷ The estimate is based on a predicted 67% increase in the annual number of hospitalizations—assuming that other factors such as age-specific hospitalization rates and lengths of stay do not change—and derived from U.S. Census Bureau projections that by 2050 the U.S. population will increase by 41%. Total U.S. hospital capacity has steadily decreased for the past three decades.

Larry Beresford is a freelance writer in Alameda, Calif.

72%

Total growth in hospital capacity needed by the year 2050, according to an analysis in the Journal of Hospital Medicine.⁷ The estimate is based on a predicted 67% increase in the annual number of hospitalizations—assuming that other factors such as age-specific hospitalization rates and lengths of stay do not change—and derived from U.S. Census Bureau projections that by 2050 the U.S. population will increase by 41%. Total U.S. hospital capacity has steadily decreased for the past three decades.

Larry Beresford is a freelance writer in Alameda, Calif.

72%

Total growth in hospital capacity needed by the year 2050, according to an analysis in the Journal of Hospital Medicine.⁷ The estimate is based on a predicted 67% increase in the annual number of hospitalizations—assuming that other factors such as age-specific hospitalization rates and lengths of stay do not change—and derived from U.S. Census Bureau projections that by 2050 the U.S. population will increase by 41%. Total U.S. hospital capacity has steadily decreased for the past three decades.

Larry Beresford is a freelance writer in Alameda, Calif.

Costs of Care (www.costsofcare.org), a nonprofit dedicated to empowering patients and their caregivers to deflate medical bills, and the American Board of Internal Medicine (ABIM) Foundation plan to launch their second annual Teaching Value and Choosing Wisely Competition this fall to highlight healthcare innovations promoting value. The submission deadline is Feb. 1, 2015.

The Teaching Value Project, the main educational arm of Costs of Care, has developed web-based video training modules based on actual cases, along with other educational materials to help residents and medical students learn to make clinical decisions optimizing quality and cost, says Christopher Moriates, MD, hospitalist and co-chair of the University of California-San Francisco’s High-Value Care Committee.

Details of the contest will be posted at www.teachingvalue.org. For more information, send an e-mail to TeachingValue@CostsofCare.org.

Larry Beresford is a freelance writer in Alameda, Calif.

Costs of Care (www.costsofcare.org), a nonprofit dedicated to empowering patients and their caregivers to deflate medical bills, and the American Board of Internal Medicine (ABIM) Foundation plan to launch their second annual Teaching Value and Choosing Wisely Competition this fall to highlight healthcare innovations promoting value. The submission deadline is Feb. 1, 2015.

The Teaching Value Project, the main educational arm of Costs of Care, has developed web-based video training modules based on actual cases, along with other educational materials to help residents and medical students learn to make clinical decisions optimizing quality and cost, says Christopher Moriates, MD, hospitalist and co-chair of the University of California-San Francisco’s High-Value Care Committee.

Details of the contest will be posted at www.teachingvalue.org. For more information, send an e-mail to TeachingValue@CostsofCare.org.

Larry Beresford is a freelance writer in Alameda, Calif.

Costs of Care (www.costsofcare.org), a nonprofit dedicated to empowering patients and their caregivers to deflate medical bills, and the American Board of Internal Medicine (ABIM) Foundation plan to launch their second annual Teaching Value and Choosing Wisely Competition this fall to highlight healthcare innovations promoting value. The submission deadline is Feb. 1, 2015.

The Teaching Value Project, the main educational arm of Costs of Care, has developed web-based video training modules based on actual cases, along with other educational materials to help residents and medical students learn to make clinical decisions optimizing quality and cost, says Christopher Moriates, MD, hospitalist and co-chair of the University of California-San Francisco’s High-Value Care Committee.

Details of the contest will be posted at www.teachingvalue.org. For more information, send an e-mail to TeachingValue@CostsofCare.org.

Larry Beresford is a freelance writer in Alameda, Calif.

The role of nonclinical factors in shaping rates of rehospitalization has been explored in several recent studies—and targeted through new legislation endorsed by the Society of Hospital Medicine. A study in Health Affairs compared hospital performance on 30-day readmissions for the first three diagnoses included in penalty calculations for CMS’ Hospital Readmissions Reduction Program (HRRP) and found that adjusting for patients’ socioeconomic status significantly reduced the rates of variation in readmissions between hospitals across the state of Missouri.¹

For patients discharged between 2009 and 2012, analysis using a model enriched with census tract socioeconomic data found that the range of variation in readmissions between hospitals decreased to 1.8% from 6.5% for patients with acute myocardial infarction; to 7.4% from 14.0% for congestive heart failure; and to 3.7% from 7.4% for pneumonia, compared with rates unadjusted for these socioeconomic factors. Another study in the same journal by researchers at an urban teaching hospital found that patients living in high-poverty neighborhoods were 24% more likely to be readmitted to the hospital within 30 days, after adjusting for demographic and clinical characteristics.²

For a factor that may be more amenable to intervention by hospitalists, a standardized rehabilitation medicine test measuring patients’ ability to perform everyday tasks of living, such as the ability to move independently from bed to chair, wheelchair, or toilet was found to be a good predictor of readmissions.³ Few hospitals currently require assessment of their patients’ functional ability, notes the study’s lead author Erik Hoyer, MD, assistant professor in the department of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine in Baltimore. But the score “is a direct reflection of the patient’s ability to heal [outside of the hospital].”

The Functional Independence Measure used in this study and in inpatient rehabilitation facilities nationwide is probably not the right tool for hospitalists because of its length and the training required to administer it, Dr. Hoyer says.

“There are other, easier tools that are available or in development that may also serve a similar purpose,” he says. “The main point is that routine functional assessment is important in the hospital setting, and developing strategies to improve patient function is likely an important way to improve outcomes such as hospital readmissions.”

The documented role of socioeconomic status in determining readmissions also is addressed by legislation introduced by Rep. Jim Renacci (R-Ohio) and supported by both the Society of Hospital Medicine and the American Hospital Association. The Establishing Beneficiary Equity in the Hospital Readmission Program Act (HR-4188) would adjust HRRP readmissions penalties to reflect “certain socioeconomic and health factors that increase the patient’s risk of readmissions.”

Larry Beresford is a freelance writer in Alameda, Calif.

The role of nonclinical factors in shaping rates of rehospitalization has been explored in several recent studies—and targeted through new legislation endorsed by the Society of Hospital Medicine. A study in Health Affairs compared hospital performance on 30-day readmissions for the first three diagnoses included in penalty calculations for CMS’ Hospital Readmissions Reduction Program (HRRP) and found that adjusting for patients’ socioeconomic status significantly reduced the rates of variation in readmissions between hospitals across the state of Missouri.¹

For patients discharged between 2009 and 2012, analysis using a model enriched with census tract socioeconomic data found that the range of variation in readmissions between hospitals decreased to 1.8% from 6.5% for patients with acute myocardial infarction; to 7.4% from 14.0% for congestive heart failure; and to 3.7% from 7.4% for pneumonia, compared with rates unadjusted for these socioeconomic factors. Another study in the same journal by researchers at an urban teaching hospital found that patients living in high-poverty neighborhoods were 24% more likely to be readmitted to the hospital within 30 days, after adjusting for demographic and clinical characteristics.²

For a factor that may be more amenable to intervention by hospitalists, a standardized rehabilitation medicine test measuring patients’ ability to perform everyday tasks of living, such as the ability to move independently from bed to chair, wheelchair, or toilet was found to be a good predictor of readmissions.³ Few hospitals currently require assessment of their patients’ functional ability, notes the study’s lead author Erik Hoyer, MD, assistant professor in the department of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine in Baltimore. But the score “is a direct reflection of the patient’s ability to heal [outside of the hospital].”

The Functional Independence Measure used in this study and in inpatient rehabilitation facilities nationwide is probably not the right tool for hospitalists because of its length and the training required to administer it, Dr. Hoyer says.

“There are other, easier tools that are available or in development that may also serve a similar purpose,” he says. “The main point is that routine functional assessment is important in the hospital setting, and developing strategies to improve patient function is likely an important way to improve outcomes such as hospital readmissions.”

The documented role of socioeconomic status in determining readmissions also is addressed by legislation introduced by Rep. Jim Renacci (R-Ohio) and supported by both the Society of Hospital Medicine and the American Hospital Association. The Establishing Beneficiary Equity in the Hospital Readmission Program Act (HR-4188) would adjust HRRP readmissions penalties to reflect “certain socioeconomic and health factors that increase the patient’s risk of readmissions.”

Larry Beresford is a freelance writer in Alameda, Calif.

The role of nonclinical factors in shaping rates of rehospitalization has been explored in several recent studies—and targeted through new legislation endorsed by the Society of Hospital Medicine. A study in Health Affairs compared hospital performance on 30-day readmissions for the first three diagnoses included in penalty calculations for CMS’ Hospital Readmissions Reduction Program (HRRP) and found that adjusting for patients’ socioeconomic status significantly reduced the rates of variation in readmissions between hospitals across the state of Missouri.¹

For patients discharged between 2009 and 2012, analysis using a model enriched with census tract socioeconomic data found that the range of variation in readmissions between hospitals decreased to 1.8% from 6.5% for patients with acute myocardial infarction; to 7.4% from 14.0% for congestive heart failure; and to 3.7% from 7.4% for pneumonia, compared with rates unadjusted for these socioeconomic factors. Another study in the same journal by researchers at an urban teaching hospital found that patients living in high-poverty neighborhoods were 24% more likely to be readmitted to the hospital within 30 days, after adjusting for demographic and clinical characteristics.²

For a factor that may be more amenable to intervention by hospitalists, a standardized rehabilitation medicine test measuring patients’ ability to perform everyday tasks of living, such as the ability to move independently from bed to chair, wheelchair, or toilet was found to be a good predictor of readmissions.³ Few hospitals currently require assessment of their patients’ functional ability, notes the study’s lead author Erik Hoyer, MD, assistant professor in the department of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine in Baltimore. But the score “is a direct reflection of the patient’s ability to heal [outside of the hospital].”

The Functional Independence Measure used in this study and in inpatient rehabilitation facilities nationwide is probably not the right tool for hospitalists because of its length and the training required to administer it, Dr. Hoyer says.

“There are other, easier tools that are available or in development that may also serve a similar purpose,” he says. “The main point is that routine functional assessment is important in the hospital setting, and developing strategies to improve patient function is likely an important way to improve outcomes such as hospital readmissions.”

The documented role of socioeconomic status in determining readmissions also is addressed by legislation introduced by Rep. Jim Renacci (R-Ohio) and supported by both the Society of Hospital Medicine and the American Hospital Association. The Establishing Beneficiary Equity in the Hospital Readmission Program Act (HR-4188) would adjust HRRP readmissions penalties to reflect “certain socioeconomic and health factors that increase the patient’s risk of readmissions.”

Larry Beresford is a freelance writer in Alameda, Calif.