Photo: Naoki Takano via Flickr
Researchers and health policy experts are questioning the value of Medicare’s efforts to reduce 30-day hospital readmissions.
The latest example came this week when Health Affairs published research on what happened after Medicare added hip and knee replacement surgeries to the list of conditions for which it would penalize hospitals for having high rates of readmissions.
South Florida Sun Sentinel reporters Sally Kestin and Bob LaMendola report that, despite the myriad initiatives and protocols launched in the dozen years since a landmark report thrust medical errors into the headlines, little progress has been made in actually reducing the toll taken by medical errors.
“I don’t really see any improvement in patient safety,” said Dr. Arthur Palamara, a Hollywood vascular surgeon and advocate for safer practices. “Unfortunately, despite all the protocols that were put in place, the adverse incidents, the wrong-site surgeries still keep happening at the same rate.”
A long list of technological advances and a national emphasis on preventing mistakes “hasn’t made a difference,” said Douglas Dotan, chief executive of CRG Medical, a Houston firm that sets up error-prevention systems…
They found that, while some progress has been made, even the most aggressive hospitals have found it difficult to crack the exceeding complex web of human and mechanical interactions that make errors possible.
These findings, which have become a depressingly predictable event, are built in part on research published in the April, 2011 issue of Health Affairs, a publication to which AHCJ members are granted free access.
In The Providence Journal, reporter and AHCJ board member Felice Freyer reports on the local effects of the national trend toward higher proportions of minority residents in nursing homes. In addition to the logistical concerns raised by this demographic shift, Freyer also explores what it says about health disparities and access to care in minority communities.
Freyer’s report is built on a Brown University study published in the July edition of Health Affairs. As you may know, free access to Health Affairs is one of the many benefits that come with your AHCJ membership.
… between 1999 and 2008, the number of Hispanics and Asians living in U.S. nursing homes grew by 54.9 percent and 54.1 percent, respectively, while the number of whites dropped 10.2 percent.
These numbers reflect the changing demographic profile of elderly people, whose ranks include growing numbers of blacks, Hispanics and Asians. But the researchers say their findings also raise questions about whether minority-group members have poorer access to assisted-living and community-based care. The question may be especially relevant as states such as Rhode Island strive to “rebalance” the long-term system to favor home-based care over institutional care.
Freyer’s story also includes data from Brown’s LTCfocus.org site, a handy tool for sorting and visualizing data related to long term care and nursing homes.
The April issue of Health Affairs focuses on the quality of health care in the United States. Some highlights of the issue, which was sponsored by the Robert Wood Johnson Foundation:
Those of you who attended Health Journalism 2010 might be particularly interested in an update from Peter J. Pronovost, M.D., who was the keynote speaker at last year’s conference. In this issue of Health Affairs, Pronovost writes about the advances in reducing central line-associated bloodstream infections – which he discussed at last year’s talk.
Remember, AHCJ members receive free access to Health Affairs. If you haven’t already signed up for access, be sure you take advantage of that benefit.
Earlier this month, ECRI’s 17th annual conference tackled the thorniest detail of comparative effectiveness research, namely that it’s rarely a simple matter of A > B. Groups and individuals respond differently.
With a theme of “Comparative Effectiveness and Personalized Medicine,” the nonprofit and its partners at NIH and Health Affairs, among others, sought to better understand how big research ideas will interface with the person-by-person decisions through which such work will ultimately be implemented.
The conference has a detailed postmortem online, including two days of video (Fair warning: Together, they’re a good 700+ minutes of conference) and slides from a number of the presentations. I strongly recommend using the conference schedule listed on the slides page as a rough guide to finding the most relevant bits of video.
In case you’re looking for a place to start, here are two of the most relevant presentations:
The online Q and A is also interesting, though there are only a handful of answers up at present. The most relevant one so far comes from Vivian Coates (Vice President, Information Services and Health Technology Assessment, ECRI Institute), in response to a query about a central listing of comparative effectiveness projects.
The CER inventory contract was awarded to the Lewin Group Center for Comparative Effectiveness Research (CER) in June, 2010. Over the 27 month period of the contract, Lewin will design, build and launch a web-based inventory that catalogs CER outputs and activity, including research studies, relevant research methods, training of researchers, data infrastructure and approaches for dissemination and translation of comparative effectiveness research to health care providers and patients.
