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Post Gazette

Hospital-acquired infections statewide decreased more than 3 percent in 2011, according to the annual report by the Pennsylvania Department of Health released Wednesday. The report is based on the number of infections that were catheter-associated urinary tract infections, central-line blood stream infections and six types of surgical site infections. Those infections are generally considered indicators of hospitals’ overall quality control for preventing infections.

Southern California Public Radio
 
Cedars-Sinai Medical Center in Los Angeles and six other hospitals released results of a national project aimed at cutting hospital infections that each year sicken nearly two million patients and kill about 100,000 people nationwide.
 
“Surgical site infections are a big problem in health care,” said Dr. Mark R. Chassin, president of the Joint Commission hospital regulating group, which along with the American College of Surgeons sponsored the seven-hospital project. “They are a major cause of patient injury and death. They prolong hospitalization and increase costs.”
 
The project lasted 30 months and focused on measures to make colorectal surgeries safer. Chassin said patients who undergo colorectal surgeries for such conditions as colorectal cancer, inflammatory bowel disease or Crohn’s Disease have a disproportionately high number of associated infections due to the abundance of bacteria found in the colon.
 
Through the duration of the project, Chassin said, the seven hospitals adopted various measures that helped them reduce infections by 32 percent – or 135 cases. Fewer infections also saved the hospitals $3.7 million.
 
The results at Cedars-Sinai were even better than average, according to Dr. Shirin Towfigh, the surgeon who led that hospital’s participation in the project
 
Towfigh told reporters in a telephone news conference that before the project began, colorectal surgical patients at Cedars-Sinai had a 15.5 percent chance of infection.
 
“We brought that down to five-and-a-half percent and since July we have maintained that below five percent,” she said.
 
Twofigh said many of the changes involved simple measures such as making sure patients shower with anti-bacterial soaps before surgery and having surgery teams change protective clothing and instruments during a procedure to prevent the spread of germs picked up in earlier stages of the surgery.
 
The other hospitals involved in the project were Cleveland Clinic in Ohio; Mayo Clinic-Rochester Methodist Hospital in Rochester, Minn.; North Shore-Long Island Jewish Health System in Great Neck, NY; Northwestern Memorial Hospital in Chicago; OSF Saint Francis Medical Center in Peoria, Ill.; and Stanford Hospital & Clinics in Palo Alto.
 
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USA Today

George Halvorson built Kaiser Permanente into the nation’s largest managed care company and hospital system over 10 years as its chief executive. In an interview with USA TODAY reporter Jayne O’Donnell, Halvorson talked about the wisdom of empowering doctors to make health care decisions, why the rest of health care is not making the best medical choices and why he has the best job in health care but plans to retire next year anyway. These excerpts from the interview were edited for clarity and space.
 
Q: Explain how your business model works and how it differs from your competitors.
 
A: Kaiser Permanente is a vertically integrated care system. We insure care and deliver care. We sell care by the package, not by the piece. We have 180,000 employees, 9 million members, over 500 care sites and own our laboratories, pharmacies and imaging centers. We take care of the entire patient and can focus on things like preventing broken bones. We have one of the lowest stroke rates. We focus on early detection, best care and we do the right followup care. We have the lowest sepsis death rate. Sepsis kills more patients than cancer, stroke or heart disease. Pressure ulcers generate a lot of revenue in a lot of care settings. We make sure people don’t get pressure ulcers. Because we are prepaid, we don’t make our money by having care go wrong.
 
We need to stop rewarding the infrastructure of American health care for making mistakes.
 
Most of (our competitors) … don’t get paid for prevention. Their financial model penalizes them if they prevent someone from breaking a bone. Thanks to aggressive early detection, we have fewer cases of late-stage cancer. That’s one of our goals: having fewer cancers get to stage four. Many people are alive today who would be dead if they were getting care from any other care system,
 
Q: So how do your competitors react when you say they’re rewarded for not preventing injury and disease?
 
A: Many of the care systems want to become accountable care organizations so they could become more Kaiser-like. Some of them would do it extremely well.
 
Fee-for-service is a dangerous financial model for many people. If you re-engineer care delivery to make it better and eliminate the billable pieces, every billable piece you eliminate cuts revenue. One of the great health care institutions on the West Coast figured out which patients should get imaging — their CT scans, their MRI scans — and did a quality-based assessment. They did a great job figuring out which patients needed that care and dropped their revenue by 25% to 30%.
 
It’s so important to have medical homes (where physicians work closely with nurses, pharmacists, therapists, imaging technicians and other caregivers under the same roof) and accountable care organizations (ACOs) that are focused on the total package of care.
 
Q: As states move toward health exchanges, they’re using places like Kaiser as a model. Are others consulting with you these days?
 
A: We are giving a lot of advice these days. People particularly that are trying to set up ACOs are looking at us as a model. People who are looking at doing medical homes are looking at us for how medical homes can be part of an overall care system if the Affordable Care Act is implemented in 2014 on schedule.
 
Q: Kaiser Permanente is not-for-profit, but some says Kaiser’s rates are not significantly below what others charge.
 
A: In all markets, we average 10% or more less expensive than the competition. Hewitt just did a national survey of all the care systems and concluded we are 10% more cost-effective than the average HMO and 16% more cost-effective than all plans in the markets we serve.
 
Q: Is there a consumer perception issue for Kaiser that low cost equals low quality?
 
A: That perception was true more so 10 years ago. We’ve won so many quality standards. If you look at the Centers for Medicare and Medicaid Services’ ratings of 563 Medicare Advantage plans, only 11 got five stars based on 53 measures of quality and service. We only had one that didn’t. People in the care-delivery world know that. We have 10 applicants for every opening. We pay primary care (doctors) over community standards in private practice.
 
Q: Can you really deliver the best for everyone in your system? What if someone has a rare form of cancer? Is there any procedure you don’t do at Kaiser?
 
A: We have 6,000 patients in cancer clinical trials and our cancer outcomes that are better than the national average. We have half of the radiologists that graduate from Harvard Medical School. Surgical specialists love working for Kaiser Permanente because they get great facilities and are not driven in any way to do a surgery to make money. We buy our surgeons by the month, not by the cut, which is a different way. If you think about it, why wouldn’t you want to work for KP? We don’t do heart transplants internally. We do wonderful heart surgery, but we send our transplants elsewhere.
 
Q: What’s your reaction to the proposed merger of Aetna and Coventry Health Care?
 
A: It’s fascinating. I encourage them to go down that path. It looks a lot like us. They’re attempting to do with that combination what we do every day.
 
Q: Some suggest your success rates have a lot to do with the fact you cover more younger and healthier people. What do you say to that?
 
A: We have the highest loyalty level. People stay with us longer than any other health plan. Our average population is slightly older. About 1.1 million of our 9 million members are 65 and up.
 
Q: You are scheduled to step down at the end of 2013 and Kaiser is searching for a new CEO now. What capabilities do you think your successor should have and what challenges will he or she face?
 
A: Whoever succeeds me should really enjoy the full potential of working with a vertically integrated care system. I don’t think there’s a better job in health care. When I joined KP, I had a sense we needed to do a few things, like computerize the medical records. We did that work. It’s doing exactly what I hoped it would do. I’m feeling like I accomplished what I came to do.
 
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Reuters
 
There may be several non-medical factors outside of hospitals’ control that are linked to how heart and pneumonia patients fare once they’re discharged, according to a fresh look at past research.
 
Beginning October 1, the Centers for Medicare and Medicaid Services (CMS) started using readmission rates and patient outcomes as a way to determine how much money hospitals should get paid.
 
But CMS does not consider so-called social factors, such as a patient’s living situation or low income, when profiling the quality of a hospital’s care.
 
In the new study, published in the Journal of General Internal Medicine, researchers analyzed data from 72 previous papers examining the reasons people died or were readmitted to the hospital, and found that age, race, employment status, living situation, education and income levels are just some of the factors that may play a role.
 
“We don’t yet know how to accurately measure (the factors), but I think we found enough information to say that they are important and that they should continue to be studied and accounted for,” said lead author Dr. Linda Calvillo-King, an assistant professor of internal medicine at the University of Texas Southwestern Medical Center in Dallas.
 
SOCIAL FACTORS

Calvillo-King said she decided to look this topic when she noticed that patients at her hospital were readmitted because of issues like not being able to take their medication or being unable to get to doctors’ offices.
 
So she and her colleagues gathered research that examined social factors and hospital readmissions in heart and pneumonia patients over about 30 years.
 
Overall, the researchers were able to pull information from 20 studies looking at pneumonia and 52 looking at heart failure.
 
For pneumonia patients, among the factors linked to the risk of being readmitted to the hospital were being older and not white. Having a low level of education, low income and being unemployed were also tied to a higher risk of going back into the hospital.
 
Being older and being a man were each associated with a greater chance of dying within the 30 days after being released from a hospital, as was being a nursing home resident.
 
For example, in one study from 2002 that was included in the analysis, researchers found that about 17 percent of nursing home residents died after being hospitalized with pneumonia, compared to about 10 percent of other Medicare patients.
 
For heart failure patients, the risk of being readmitted to a hospital was tied to being elderly, African American or Hispanic.
 
The type of insurance a person had, their marital status and economic status were also among the factors tied to heart patients’ risk of being readmitted to a hospital - as were risky behaviors, such as smoking and cocaine use.
 
Many of the same factors were linked both to a heart failure patient’s risk of death after being hospitalized and the risk of readmission to the hospital.
 
Some studies also found that living far away from a hospital and feeling cold at home were linked to an increased risk of dying for heart failure patients.
 
MORE RESEARCH NEEDED

Although Calvillo-King and her colleagues were able to look at a large number of studies, they were all vastly different, she noted.
 
One study analyzed data for as few as 54 patients, while another looked at more than 8 million.
 
The studies also included diverse populations and different kinds of social factors, Calvillo-King said.
 
For example, she told Reuters Health that only some of the studies included details of a patient’s social environment, such as their living situation, medications, smoking and substance abuse.
 
The researchers cannot say for certain that the risk factors identified are what cause a patient to die or to be sent back to the hospital.
 
But they note in their report that this kind of information could be used by doctors, case managers and discharge planners to flag patients at high risk of readmission because of certain non-medical vulnerabilities, and “Different and more intensive follow-up strategies will likely be necessary in these high social-risk patients….”
 
Future studies should focus on which factors are the most important, how they should be accounted for and how to address them, Calvillo-King said. “As a physician, these are things that should be taken into account or publicly reported. There is not a lot of research about how that would be done, or what social factors to focus on.”
 
Particularly since CMS compares hospitals “according to 30-day readmission and mortality rates,” the researchers write, identifying the social factors that affect patient outcomes and yet are beyond a hospital’s control could make assessments of the care patients actually do get in the hospital more accurate.
 
The Centers for Medicare and Medicaid Services did not provide a statement by press time.
 
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Huffington Post

The United States spends more on health care - $2.6 trillion in 2010 - than any other nation in the world. Despite this enormous investment in our national health, we rank 37th in health-care quality behind Greece, Colombia, Chile and Costa Rica.
 
Among the many causes of this disparity, three stand out: unnecessary care, uncoordinated care and avoidable care. The Economist estimates that these three inefficiencies alone account for over $300 billion dollars per year in unnecessary spending. We will focus on one area in particular - avoidable hospital readmissions. According to the Medicare Payment Advisory Committee,almost 1 in 5 Medicare patients will be readmitted to the hospital within 30 days of discharge. Beside the $15 billion in financial costs, these readmissions have another, less obvious cost — a heavy emotional and health toll on the patients and their families.
 
Avoidable hospital readmissions are typically caused by insufficient post-hospitalization care, failure to adhere to recommended medication or therapy regimens and lack of physical support for the discharged patient. Beginning this year, the Centers for Medicare and Medicaid have changed their reimbursement schedule to essentially penalize hospitals with high readmission rates. Hospitals and health-care professionals across the nation are teaming up with care facilities, home care agencies and other sources of post-hospitalization support in order to adapt to the new regulations. Ideally, this will mean better long-term care for patients and broader support for recovery at home.
 
While medical providers are implementing procedures to prevent readmissions, patients and families should take note of a few important tips to facilitate a successful transition from hospital to home. The best thing you can do if your loved one is hospitalized is to gather information — learn about skilled nursing, home health care and private duty home care; consider recovery options at home or within facilities; collect opinions from the doctors, nurses and discharge planners within the hospital. Our Hospital to Home Care website outlines the full discharge and post-hospitalization care process; we’ve also included 10 helpful hints for families planning for a hospital discharge in this post. Understand your care options prior to discharge. If your loved one prefers to recover at home, make these feelings known to the hospital discharge team.
 

Bring this information and the medication list with you to any follow-up medical appointments.
Planning for discharge is the first step of the post-hospitalization recovery process, but the road to recovery can be long and trying. The stress of recovery takes its toll on the entire family; individuals who care for a loved one suffer from fatigue, exhaustion and weakened immune systems. Over half of all family caregivershave some clinically significant symptoms of depression. Take advantage of the free information and resources available to you and contact a professional if you need further support.
 
Dr. David Carr, clinical director of the Division of Geriatrics and Nutritional Science at Washington University School of Medicine, agrees:

Hospital readmissions are not only detrimental to a patient’s mental and physical health and expensive, but they can result in hospital penalization. Readmissions are often the result of inadequate support and supervision following the patient’s discharge orders upon returning home. Having a structured, professional Hospital to Home program like the one offered by Home Care Assistance promises benefits to the patient and the hospital by working in conjunction with the patient’s medical team to ensure discharge orders are followed and intervention occurs before a readmission is necessary.

 
We often mistakenly assume that we can’t play a role in the efficiency of our institutions. We can prevent thousands of avoidable hospital readmissions by being proactive and availing ourselves of the resources in our communities. Together, we can help create a healthier America and a more cost-efficient health care system.
 
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