P4P Diabetes Program Reduces Hospitalizations and Long-Term Expense
A study examining the long-term effects of a pay-for-performance (P4P) program for diabetes care on health care utilization and expenses found patients in the pay-for-performance program underwent significantly more diabetes-specific examinations and tests after enrollment. Patients in the intervention groups also had a significantly higher number of diabetes-related physician visits in only the first year after enrollment and had fewer diabetes-related hospitalizations in the follow-up period. The Taiwan-based study found that overall health care expenses for patients in the intervention groups were higher than those of the comparison group in the first year; however, the continual enrollees spent significantly less than their counterparts in the subsequent years. S. Chang, T. Lee, and C. Chen, "A Longitudinal Examination of a Pay-for-Performance Program for Diabetes Care: Evidence from a Natural Experiment," Medical Care, Feb. 2012 50(2):109–16.
Cost and Intensity of Care in U.S. Hospitals Rises with Connectedness of Network Physicians
A study that sought to determine whether variation in the cost and intensity of care delivery in U.S. hospitals is influenced by relationships among doctors, found that, hospitals with doctors who have high numbers of connections have higher costs and more intensive care, and hospitals with primary care–centered networks have lower costs and care intensity. The study found that for the average-sized urban hospital, an increase of one standard deviation in the median number of connections per physician was associated with a 17.8 percent increase in total spending,as well as 17.4 percent more hospital days and 23.8 percent more physician visits. A higher centrality of primary care providers within these hospital networks was associated with 14.7 percent fewer medical specialist visits and lower spending on imaging and tests. M. Barnett, N. A. Christakis, J. O'Malley et al., "Physician Patient-Sharing Networks and the Cost and Intensity of Care in U.S. Hospitals," Medical Care, Feb. 2012 50(2):152-60.
Timing and Use of Outpatient Follow-Up Visits Not Linked to Readmission Rates
A study designed to evaluate the relationship between outpatient follow-up appointments and 30-day unplanned readmissions found the timing of post-discharge follow-up did not affect readmission rates. The study analyzed 1,044 patients discharged from a tertiary care academic medical center, 49.6 percent of whom had scheduled follow-up 14 or fewer days after discharge, 4.9 percent of whom were scheduled 15 or more days after discharge, and 45.4 percent of whom had no scheduled follow-up. The study found there was no statistical difference in 30-day readmissions between patients with follow-up within 14 days and those with follow-up 15 days or longer from discharge or between patients with follow-up within 14 days and those without scheduled follow up. D. T. Kashwagi, M. C. Burton, L. L. Kirkland et al., "Do Timely Outpatient Follow-up Visits Decrease Hospital Readmission Rates?" American Journal of Medical Quality, Jan./Feb. 2012 27(1):11–15.
Poor Health Status on Admission Tied to Adverse Events
A study that investigated the effect of patients' health status upon admission on adverse events and added hospital costs found that admission severity increased the likelihood of all types of adverse events. It also found seven specific comorbidities were associated with increased events and two other comorbidities were associated with decreased events. High admission severity also increased incremental costs and length of stay. The authors recommended that adverse event reporting should incorporate comorbidity and admission severity and that reimbursement incentives to improve patient safety consider adjustment for health status on admission. J. M. Naessens, C. R. Campbell, N. Shah et al., "Effect of Illness Severity and Comorbidity on Patient Safety and Adverse Events,"American Journal of Medical Quality, Jan./Feb. 2012 27(1):48–57
A Voluntary Approach to Reducing HAIs
An overview of a voluntary, statewide effort to reduce health care–associated infections in Iowa noted the program—which was successful at increasing timely and appropriate use of antimicrobial agents for treatment of community-acquired pneumonia or prevention of surgical site infections —summarizes the program's three initiatives: developing and implementing a public reporting system for hospital performance measures; participation in the Institute for Health care Improvement's 100,000 Lives and 5 Million Lives campaigns; and a campaign to increase immunizations among health care workers. M. M. Ward, G. Clabaugh, T. C. Evans et al., "A Successful, Voluntary, Multicomponent Statewide Effort to Reduce Health Care–Associated Infections," American Journal of Medical Quality, Jan./Feb. 2012 27(1):66–7.
Longer Length of Stay Correlated with Higher Mortality Rates
A study that compared hospital performance for acute myocardial infarction, heart failure, and pneumonia using two measures—in-hospital mortality and 30-day mortality—found mean length of stay was positively correlated with in-hospital mortality for all three conditions. These results suggest that performance measures based on in-hospital mortality favor hospitals with shorter lengths of stay. E. E. Drye, S. T. Normand, Y. Wang et al., "Comparison of Hospital Risk-Standardized Mortality Rates Calculated by Using In-Hospital and 30-Day Models: An Observational Study with Implications for Hospital Profiling," Annals of Internal Medicine, Jan. 2012 156(1):19–26.
Multifaceted Diabetes Initiative Targets Disparities
An effort to improve health outcomes and reduce health disparities among patients with diabetes used a four-pronged approach that included a quality improvement collaborative involving providers from six health centers; a peer support and patient education program that encouraged patients to identify and use community resources including local walking programs; provider training on patient-centered communication and cultural competency; and the use of community partnerships to identify and support patients without access to primary care. M. E. Peek, A. E. Wilkes, T. S. Roberson et al., "Early Lessons from an Initiative on Chicago's South Side to Reduce Disparities in Diabetes Care and Outcomes," Health Affairs, Jan. 2012 31(1):177–86.
HIT-Supported Improvement Initiatives Reduce Some Disparities, But Not All
A study examining the effects of a multifaceted, health information technology–supported quality improvement initiative on disparities in ambulatory care focused on process of care and intermediate outcome measures for coronary heart disease, heart failure, hypertension, and diabetes, as well as receipt of several preventive services. It found quality of care improved for 14 of 17 measures among white patients and 10 of 17 measures among black patients. Further, quality improved for both white and black patients for five of eight process-of-care measures, four of five preventive services, but none of the four intermediate outcome measures. The authors concluded generalized and provider-directed quality improvement initiatives can decrease racial disparities for some chronic disease and preventive care measures, but achieving equity in areas with persistent disparities will require more targeted, patient-directed, and systems-oriented strategies. M. Jean-Jacques, S. D. Persell, J. A. Thompson et al., "Changes in Disparities Following the Implementation of a Health Information Technology–Supported Quality Improvement Initiative," Journal of General Internal Medicine, Jan. 2012 27(1):71–7.
Automated Telemonitoring System Significantly Reduces Readmission Rates
A study of a post-hospital discharge telemonitoring system that sought to determine if the use of the system reduced 30-day hospital readmission rates among Medicare patients found the program was associated with a 44 percent reduction in 30-day readmissions. The authors concluded that the combination of telemonitoring and case management, as compared with case management alone, may significantly reduce readmissions in a Medicare Advantage population. J. Graham. J. Tomcavage, D. Salek et al., "Postdischarge Monitoring Using Interactive Voice Response System Reduces 30-Day Readmission Rates in a Case-managed Medicare Population," Medical Care, Jan. 2012, 50(1):50–7.
AHRQ's Patient Safety Indicators May Require Additional Coding for Accuracy
A study designed to determine how accurately the Agency for Healthcare Research and Quality's (AHRQ) Patient Safety Indicators (PSIs) identified true safety events looked at medical charts the PSIs flagged in the Veterans Health Administration system. They found the positive predictive value of 12 selected PSIs ranged from 28 percent for postoperative hip fracture to 87 percent for postoperative wound dehiscence. Common reasons for false positives included conditions that were present on admission, coding errors, and lack of coding specificity. The authors concluded that additional coding improvements are needed before the PSIs they evaluated are used for hospital reporting or pay for performance. A. K. Rosen, K. Itani, M. Cevasco et al., "Validating the Patient Safety Indicators in the Veterans Health Administration: Do They Accurately Identify True Safety Events?" Medical Care, Jan. 2012 50(1):74–85.
Health Coaching Program Does Not Reduce Utilization, Expenditures
A study that examined the effect of a telephone-based health coaching program on health care utilization and expenditures among Medicaid members with chronic conditions found the health coaching program did not demonstrate significant effects on utilization or expenditures. Changes in acute hospitalizations, ambulatory care visits, and Medicaid expenditures before and after program enrollment were similar among program members and the comparison group. W. Lin, H. Chien, G. Willis et al., "The Effect of a Telephone-Based Health Coaching Disease Management Program on Medicaid Members with Chronic Conditions," Medical Care, Jan. 2012 50(1):91–98.
Hospital Admission Rates Predictive of Readmissions
In a study that examined variation in hospital readmission rates among Medicare beneficiaries, high rates of rehospitalization were found to be significantly associated with high overall hospital admission rates. In studying the potential causes for regional differences in readmission rates, the authors found overall hospital admission rates played the biggest role, accounting for 16 percent to 24 percent of the variation in cases of congestive heart failure and 11 percent to 20 percent for pneumonia cases. Hospital referral regions with high readmission rates were more likely to have medium-sized or large hospitals and to be located in the Northeast. The study suggests that efforts to reduce readmissions must look beyond improving discharge planning and transitional care and focus on lessening incentives for hospital use. A. M. Epstein, A. K. Jha, and E. J. Orav, "The Relationship Between Hospital Admission Rates and Rehospitalizations," New England Journal of Medicine, Dec. 2011 365:2287–95.