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READMISSIONS: Continuity of care in 12 months before hospital admission reduces 30-day readmission rate

This study of over 14,000 Mayo Clinic patients cared for under a patient-centered medical home (PCMH) model looked at the concept of visit entropy, which pertains to the degree of what the authors term “disorganization” of patient care.  What this refers to is whether a patient is seen always by the same primary physician (perfect continuity of care) or whether a patient is seen by different physicians on different visits.

Statistics About These Mayo Clinic PCMH Patients

  • 14,662 patients admitted to hospital (and included in this analysis)
  • 11.6 percent readmitted within 30 days
  • 8 outpatient visits (median patient visits in 12 months before hospital admission) – this excludes any ED visits on the day of admission
  • 5 different clinicians seen (median patient during 12 months before hospital admission)

CONCLUSION

Patients with higher [visit entropy] in the 12 months before hospital admission were more likely to be readmitted or die within 30 days of hospital discharge.

Source: Garrison, G.M., and others. (2017, January-February). Visit entropy associated with hospital readmission rates. Journal of the American Board of Family Medicine, 30(1), 63-70. Click here for free full text: http://www.jabfm.org/content/30/1/63.full.pdf  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

ALZHEIMER’S: Update on the latest research

This is a 40-minute audio interview with two leading Alzheimer’s researchers, Dr. Rudolph Tanzi (Harvard) and Dr. Berislav Zlokovic (University of Southern California).  They are discussing the latest thinking and direction of research into dementia.  This discussion is intended for clinicians.

Alzheimer’s patients tend to have the disease for a long time – as long as 10 to 15 years – before symptoms occur.  One avenue of research is how to identify patients at a younger age, when they are asymptomatic.

There is an important connection between the overall health of the vascular system and staving off the accumulation of amyloid β-proteins into plaque in the brain.  The brain has some 400 miles of blood vessels and is good at quickly creating new blood vessels as needed.  Exercise prompts this.  Researchers are investigating ways to keep amyloid β – which has the function of fighting pathogens – from clumping up and failing to be cleared from the brain when their role is done and then killing neurons.  There is also investigation into what the pathogens are that are triggering the amyloid in the first place – and whether there might be possibility of a vaccine.

Source: Alzheimer outlook far from bleak. (2017, February 15). JAMA.  Click here for free access: http://jamanetwork.com/learning/audio-player/14072698  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

PHYSICIAN BURNOUT: May exceed 50 percent in U.S.

As many as half of practicing physicians may experience at least some degree of burnout – making consideration of underlying factors a key concern for health care managers and the nation as a whole.  This short commentary just posted in JAMA was written by Dr. Tait Shanafelt and colleagues at the Mayo Clinic – who are among the foremost experts in the field of clinician well-being.

The authors make specific suggestions – at the national, state, institutional, and personal  (self-improvement) levels about how to improve conditions for physicians, including among others:

  • Reduction and streamlining of required documentation
  • Integration of maintenance of certification and continuing medical education requirements
  • Implementing participatory management
  • Physician self-care

Source: Shanafelt, T.D., Dyrbye, L.N. (2017, Feb. 9). Addressing physician burnout: The way forward. JAMA. Click here for free full text: http://jamanetwork.com/journals/jama/fullarticle/2603408   Posted by AHA Resource Center (312) 422.2050 rc@aha.org

READMISSIONS: How to reduce bounce back from SNFs

After an inpatient stay in the hospital, some patients are discharged to skilled nursing facilities (SNFs) for continued recuperation and therapy.  This article summarizes the findings of a literature search of studies on how to avoid bounce back – readmission of these patients from the SNF to the hospital within 30 days.  Learnings about barriers and strategies from the 10 studies are compared in this article.

Source: Mileski, M., and others. (2017). An investigation of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility-to-hospital readmissions: A systematic review. Clinical Interventions in Aging, 12, 213-222. Click here for free full text: https://www.dovepress.com/getfile.php?fileID=34598.  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

OBGYN: Providing prenatal care in group visits

The idea of seeing expectant mothers who are at about the same stage of pregnancy together in a group for prenatal care is not new – it was described in the 1990s.  Generally, it is for low-risk patients.  Mazzoni & Carter discuss findings in the literature as to the effectiveness of this approach.  A popular model is called Centering Pregnancy, which is addressed in the other articles cited below.

Selected Sources:

Mazzoni, S.E., and Carter, E.B. (2017, February 9). Group prenatal care. American Journal of Obstetrics and Gynecology.  Click here for the publisher’s website: http://www.ajog.org/article/S0002-9378(17)30185-0/pdf

Crockett, A.H., and others. (2017, January). The South Carolina centering pregnancy expansion project: Improving racial disparities in preterm birth. American Journal of Obstetrics and Gynecology. 216(1 Supplement), S424-S425. Click here for free full text: http://www.ajog.org/article/S0002-9378(16)31441-7/pdf

Carter, E., and others. (2016, January). Group compared to traditional prenatal care for optimizing perinatal outcomes: A systematic review and meta-analysis. American Journal of Obstetrics and Gynecology. 215(1 Supplement), S382.  Click here for free full text: http://www.ajog.org/article/S0002-9378(15)02081-5/pdf

Garretto, D., and Bernstein, P.S. (2014, January). Centering Pregnancy: An innovative approach to prenatal care delivery. American Journal of Obstetrics & Gynecology, 210(1), 14-15.  Click here for free full text: http://www.ajog.org/article/S0002-9378(13)01039-9/pdf

Fausett, M., and others. (2014, January). Centering Pregnancy is associated with fewer early, but not overall, preterm deliveries. American Journal of Obsetrics & Gynecology, 210(1, Supplement), S9.  Click here for free full text: http://www.ajog.org/article/S0002-9378(13)01111-3/pdf  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

UNINSURED: 48.3 million in 2010 dropped to 28.7 million in 2015 (U.S. national data for non-elderly population)

In 1972, the earliest year shown in this source, there were 30.7 million Americans under age 65 who did not have health insurance.  This number has varied somewhat from year to year – sometimes dropping, sometimes rising – but reached the highest number (48.3 million) in 2010.  In 2015, the number of uninsured Americans under 65 who were uninsured dropped to 28.7 million.  Here are some of the years shown in this source:

Number of Persons Uninsured (under 65 years old)

  • 30.7 million  1972 (the earliest year)
  • 23.0 million  1978 (the lowest year)
  • 48.3 million  2010 (the highest year)
  • 28.7 million  2015 (the most recent year)

Source: U.S. National Center for Health Statistics. (2017, February). National Health Interview Survey: Long-term trends in health insurance coverage. Click here: https://www.cdc.gov/nchs/data/nhis/earlyrelease/trendshealthinsurance1968_2015.pdf   Posted by AHA Resource Center (312) 422-2050, rc@aha.org

POPULATION HEALTH: Are these battles winnable?

An estimated 400,000 people quit smoking between 2012 and 2016 – one of the successful initiatives of the “Winnable Battles” campaign begun by the Centers for Disease Control and Prevention in 2010.  The outcomes of this program five years later are reviewed in this report and summarized in the JAMA article.  The idea was to target a carefully-chosen set of public health issues and then devote federal, state and local resources to improving them.

Here is a summary of what happened five years on:

  1. Clear success in decreasing adult and teen smoking
  2. Likewise, exceeded the target in decreasing teen pregnancies
  3. Making good progress on most measures of reducing healthcare-associated infections – except catheter-associated urinary tract infections
  4. Slow progress on measures related to nutrition, exercise, obesity
  5. Slow progress on reducing foodborne illness
  6. Slow progress on reducing motor vehicle deaths
  7. Mixed results on measures related to HIV

Sources:

Winnable battles: Final report. (2016, November). Atlanta: U.S. Centers for Disease Control and Prevention. Click here: https://www.cdc.gov/winnablebattles/report/docs/winnable-battles-final-report.pdf; and, Frieden, T.R., Ethier, K., ad Schuchat, A. (2017, February 2). Improving the health of the United States with a “winnable battles’ initiative. JAMA. Click here: http://jamanetwork.com/journals/jama/fullarticle/2601246  Posted by AHA Resource Center (312) 422-2050, rc@aha.org