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MORTALITY: US hospital mortality rate 1.89 percent in 2013

Data from the Healthcare Cost and Utilization Project (HCUP) are available on a great free online site that you can use to run state and national statistics on hospital utilization and cost by patient diagnosis or procedures.  It’s a collection of databases, which separately address the hospital inpatient setting, children in the hospital inpatient setting, the emergency department, readmissions, and state-specific data.

Recently, a caller to the AHA Resource Center asked for a national average for HOSPITAL MORTALITY RATE.  I decided to see what could be found on this in HCUPnet.  The following data are from the National Inpatient Sample (NIS) on HCUPnet.  Another nice feature of this database is that it contains all-payer data – not limited to Medicare data.

  • 1.89 percent (672,510 inhospital deaths based on records for 35.6 million discharges) in 2013

It is easy to re-do the same query on earlier years, so I did.  The results are consistent for the five most recent years (see below).  Likewise, the number of total discharges contained in each year of the data are consistent – at about 36 to 37 million.

U.S. Hospital Mortality Rate Trends: Most recent 5 years

  • 1.89 percent (2013)
  • 1.84 percent (2012)
  • 1.87 percent (2011)
  • 1.86 percent (2010)
  • 1.89 percent (2009)

Going back to the earliest available year – 1997 – the mortality rate was 2.45 percent.

Source: U.S. Department of Health & Human Services, Agency for Healthcare Research and Quality.  HCUP national (nationwide) inpatient sample.  Click here: http://hcupnet.ahrq.gov  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

 

RESEARCH: Takes 17 years to translate to clinical practice

This is a brief interview with Andrew B. Bindman, M.D., the director of the federal Agency for Healthcare Research and Quality (AHRQ) about recent threats to the agency’s federal funding and program priorities.  Dr. Bindman mentions that one priority is to shorten the lag time that it takes for research evidence to be disseminated into use in clinical practice.  One approach is a program called EvidenceNOW that provides coaching to primary care physicians in small practices.  Another uses telemedicine and a hub-and-spoke approach to connect specialists and PCPs.  Dr. Bindman also mentions a new Comparative Health System Performance initiative intended to compare the organizational performance of multi-institutional health systems.

Source: Stephenson, J. (2016, Sept. 30). AHRQ director sets course for agency’s health services research. JAMA.  Click here: http://jama.jamanetwork.com/article.aspx?articleid=2565313   Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

Physician Practice Acquisition and Employment Trends

A new report by the Physicians Advocacy Institute (PAI) in collaboration with Avalere Health analyzes recent trends in physician employment and the acquisition of physician practices by hospitals and health systems. Physicians may become employees through a group practice acquisition, or individual physicians may enter into employment arrangements directly with hospitals/systems. Here are some highlights from the analysis:

  • Between July 2012 and July 2015, the percentage of hospital-employed physicians increased nearly 50%
  • By 2015, 38% of physicians were employed by hospitals
  • Hospital or system ownership of physician practices grew by 86% from 2012 to 2015
  • By July 2015, there were 67,000 hospital-owned physician practices
  • One in four physician practices was hospital-owned by 2015

Regionally, nearly half of all physicians in the Midwest were employed by hospitals in 2015. Physician employment rates were lowest in the South and in Alaska and Hawaii where a third of physicians were hospital-employed. The pros and cons of these employment trends are briefly listed.

PAI and Avalere are planning additional analysis of this trend and its implications for early 2017.

 

Source: Avalere Health. Physician practice acquisition study: national and regional employment changes. Physicians Advocacy Institute, Sept. 2016. http://www.physiciansadvocacyinstitute.org/Portals/0/PAI-Physician-Employment-Study.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

INFECTION CONTROL: CUSP program found to reduce UTIs in non-ICU units

The federal government funded the Comprehensive Unit-based Safety Program (CUSP), a multi-year, nationwide effort to decrease the rate of urinary tract infection associated with the use of catheters in hospitalized patients.  This project was under the leadership of AHA’s Health Research & Educational Trust (HRET).  The project involved disseminating information and tool kits about best practices and collecting data.  Data from over 600 hospitals were studied; these findings represent part of the hospitals that participated.  It was found that hospital units that were not ICUs benefited from the program – as evidenced by a reduced UTI infection rate – but ICUs did not.

Reductions occurred mainly in non-ICUs, where catheter-associated UTI rates decreased from 2.28 to 1.54 infections per 1000 catheter-days…”

Source: Saint, S., and others. (2016, June 2). A program to prevent catheter-associated urinary tract infection in acute care. The New England Journal of Medicine, 374(22), 2111-2119.  Click here for free full text: http://www.nejm.org/doi/pdf/10.1056/NEJMoa1504906  Posted by AHA Resource Center (312)422-2050, rc@aha.org

ICUs: How do high-performing hospitals reduce CLABSI rates?

This is a study out of Johns Hopkins of 17 intensive care units at 7 hospitals – comparing practices related to reducing the central line-associated bloodstream infection (CLABSI) rate.  High performers were defined as those with less than 1 infection per 1000 catheter-days over the period of at least one year.  Low performers were defined as having over 3 infections per 1000 catheter-days.

I particularly like the tables and the appendices to this article.  The tables identify characteristics of high-performers in bullet-point brevity for each of the following levels of hospital employees: senior leadership, ICU managers, infection prevention and quality improvement staff, and frontline staff.  The appendices contain specific questions that make up a CLABSI Conversation – again differentiated between senior management, infection control / quality improvement staff, and ICU staff.

Source: Pham, J.C., and others. (2016, Apr.-June). CLABSI Conversations: Lessons from peer-to-peer assessments to reduce central line-associated bloodstream infections. Quality Management in Health Care, 25(2), 67-78.  Click here for publisher’s website:  http://journals.lww.com/qmhcjournal/pages/articleviewer.aspx?year=2016&issue=04000&article=00001&type=abstract  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

New CDC Data on Emergency Department Use

The National Center for Health Statistics has just released updated numbers on emergency department use in the U.S. and the five most populous states Here are some key findings:

  • The national ED visit rate in 2012 was 42 visits per 100 persons.
  • The national percentage of ED visits resulting in an admission to the same hospital was 11%.
  • Nationwide, 63% of all ED visits were made by adults aged 18-64; children accounted for 21% of visits and the elderly 65 and over for 16%.
  • Private insurance was the expected primary source of payment for 29% of ED visits, and Medicaid or CHIP accounted for 25%.

Data is also available for California, Florida, Illinois, New York, and Texas.

Source: Hing E and Rui P. Emergency department use in the country’s five most populous states and the total United States, 2012. NCHS [National Center for Health Statistics] Data Brief, no. 252, June 2016.  https://www.cdc.gov/nchs/data/databriefs/db252.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

TRENDS: nearly 450,000 hip replacements each year

The U.S. Agency for Healthcare Research and Quality (AHRQ) has a number of free databases on the web that can be used to take an interesting historical look at health care utilization data.  I recently posted on this blog about hip fracture – and got an unusual number of hits! – so thought I might explore another aspect of the same topic here using some AHRQ data.

HIP REPLACEMENT: Inpatients discharged who had total or partial hip replacement, 1995-2013

  • 267,034 (or 100.3 per 100,000 persons) in 1995
  • 298,631 (or 105.8 per 100,000 persons) in 2000
  • 371,754 (or 125.8 per 100,000 persons) in 2005
  • 439,838 (or 142.2 per 100,000 persons in 2010
  • 439,945 (or 156.2 per 100,000 persons) in 2013

The fine print: What is this exactly?  First of all, these numbers represent inpatients only.  The rates per 100,000 persons means per 100,000 resident population.  The data source is the National Inpatient Sample based on the “CCS category” code 153: Hip replacement, total and partial.  It is also possible to run data using ICD-9 codes or DRGs.  The most current data year is 2013.

We notice from these data that both the actual number of inpatients who have had hip replacement and the rate per 100,000 persons are trending upward over time.

HIP REPLACEMENT: Ambulatory surgery?

AHRQ also has a database of ambulatory surgery procedures for 29 reporting states (representing two-thirds of the U.S. population).  As of this writing, the database can be queried for just the year 2012 but, with an added nice feature, provides comparable inpatient data for the same states.  Setting this database up for the same CCS category as above (153: Hip replacement, total and partial, all listed) shows that only about 3 percent of hip replacements were done on an outpatient basis in 2012.

Source: Agency for Healthcare Research and Quality. Welcome to HCUPnet. Click here for free access to this database http://hcupnet.ahrq.gov/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org