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NICUs: Disparities in care for very low birth weight infants

[From the medical journal literature]

Significant racial and/or ethnic variation in quality of care exists between and within NICUs.  Providing feedback of disparity scores to NICUs could serve as an important starting point for promoting improvement and reducing disparities.”

This was a study of data from the California Perinatal Quality Care Collaborative of 18,616 very low birth weight (VLBW) infants cared for in 134 neonatal intensive care units in California during the 5-year period 2010 to 2014.  Besides the conclusions on disparities (noted in the quote above), there were interesting descriptive findings about the characteristics of the VLBW infants.  Here are some of these findings:

VERY LOW BIRTH WEIGHT INFANTS

  •   9 percent (Less than 751 grams)
  • 23 percent (751-1000 grams)
  • 29 percent (1001-1250 grams)
  • 39 percent (1251-1500 grams)
  • 28 percent (multiple gestation)
  • 76 percent (C-section)
  •   4 percent (in-hospital mortality)

Source: Profit, J., and others. (2017, September), 140(3).  Click here for OPEN ACCESS to free full text: http://pediatrics.aappublications.org/content/140/3/e20170918  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

OPIOIDS: Hospital reinvents care model for NAS infants

Neonatal abstinence syndrome (NAS) refers to a withdrawal period that newborns must undergo if they have been exposed to opioids prenatally.  This study was conducted at Cabell Huntington Hospital in Huntington, WV, which is located in an area of the country with a high rate of opioid use.  At the beginning of the study period, newborns with NAS were treated in the 36-bed Level III neonatal intensive care unit at the hospital.  In mid-2012, a new unit was opened at the hospital – a 15-bed neonatal therapeutic unit (NTU) with low lights and low noise and volunteers to rock the babies.  In late 2014, a 12-bed offsite version of the NTU called Lily’s Place was opened.

Comparing Median Charges in These 3 Settings

  • $90,601 (NAS infants cared for in the NICU)
  • $68,750 (NAS infants cared for in the NTU)
  • $17,688 (NAS infants cared for at Lily’s Place – and this figure includes a brief stay in the NTU)

Sources:

Loudin, S., and others. (2017). A management strategy that reduces NICU admissions and decreases charges from the front line of the neonatal abstinence syndrome epidemic. Journal of Perinatology, 37, 1108-1111.   Click here for FREE OPEN ACCESS: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5633652/pdf/jp2017101a.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Lily’s Place video here: https://youtu.be/xoAPKF-mOfM

OPERATING ROOMS: How much major surgery is infrequent? Is there an impact on costs?

Texas hospitals were studied to see how many inpatient major surgical procedures were not performed very often (once a month or less) at each hospital analyzed.  In this study of discharge data from 343 hospitals for the period late 2015 to early 2016, over half (54 percent)  of procedures were found to be uncommon (as defined above) for the hospital where they were performed.  These procedures accounted for 68 percent of inpatient costs.

Source: O’Neill, L. and others. (2017, September). Discharges with surgical procedures performed less often than once a month per hospital account for two-thirds of hospital costs of inpatient surgery. Journal of Clinical Anesthesia. 41, 99-103. Click here for publisher’s website: http://www.jcafulltextonline.com/article/S0952-8180(17)30659-1/fulltext   Posted by AHA Resource Center (312) 422-2050, rc@aha.org

BATRIATRICS: Is gastric bypass surgery effective?

The Roux-en-Y gastric bypass procedure was found to help obese patients lose and keep weight off 12 years after surgery compared to a group of similar patients who did not have surgery.  This study, out of Intermountain Healthcare and the University of Utah, found that patients who had the surgery lost weight and were able to keep it off compared with those who did not have surgery.  Additionally, half of the surgical patients who had type 2 diabetes at the time of surgery were in remission for diabetes 12 years later.

Source: Adams, T.D., and others. (2107, September 21). Weight and metabolic outcomes 12 years after gastric bypass. New England Journal of Medicine, 377(12), 1143-1155.  Click here for the publisher’s website: http://www.nejm.org/doi/full/10.1056/NEJMoa1700459  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

UNINSURED: 28.1 million lack health insurance in 2017

The number of Americans of all ages who do not have health insurance coverage has decreased from 48.6 million in 2010 to 28.1 million in early 2017, according to survey data collected each year by the National Center for Health Statistics.  This represents a decrease from 16 percent of the population in 2010 to 8.8 percent in 2017.

About 2 million children (aged under 18 years) gained health insurance coverage in this same time period — 5.8 million had no health insurance coverage in 2010 compared to 3.9 million in early 2017.

Comparative figures going back to 1997 are also provided in this report.

Source: Norris, T., Clarke, T.C., and Schiller, J.S. (2017, September). Early release of selected estimates based on data from the January-March 2017 National Health Interview Survey. National Health Interview Survey early release program. National Center for Health Statistics. Click here: https://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201709.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

ROBOTICS: Use in interventional cardiology procedures

…contemporary robot-assisted PCI systems improve operator safety by reducing ionizing radiation exposure and can improve procedural quality and outcomes by offering better accuracy accuracy in stent selection.”

The use of surgical robots for interventional cardiology procedures in the United States is discussed in this review prepared by physicians at the Mayo Clinic.  There is one manufacturer – Corindus Vascular Robotics – and two models.  The equipment is designed to help overcome a significant problem faced by interventional cardiologists, which is exposure to radiation and the need to wear leaded protective garments during procedures.  However, there are barriers which have slowed the adoption of this technology, such as a lack of randomized clinical trials and the price tag for the equipment.

Source: Maor, E., and others. (2017, July). Current and future use of robotic devices to perform percutaneous coronary interventions: A review. Journal of the American Heart Association. 6(7).  Click here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5586317/pdf/JAH3-6-e006239.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5586317/pdf/JAH3-6-e006239.pdf

HOSPITALISTS: Scattered versus geographical assignment

In large hospitals, hospitalists may be assigned to patients in rooms scattered across the medical center or they may be assigned according to a geographical approach with each having responsibility for a particular nursing unit.  This study evaluates one hospital’s change from the scattered to the geographical assignment approach.  Hospitalists were found to appreciate the change, to credit improved quality of care based on the ability to spend more time with patients and a stronger sense of teamwork with other caregivers.  However, there was no statistically significant effect on patient length of stay, readmission rates, or patient satisfaction.

Source: Bryson, C., and others. (2017, October). Geographical assignment of hospitalists in an urban teaching hospital: Feasibility and impact on efficiency and provider satisfaction. Hospital Practice, 45(4), 135-142.  Click here for a more complete abstract on the publisher’s website: http://www.tandfonline.com/doi/abs/10.1080/21548331.2017.1353884?journalCode=ihop20  Posted by AHA Resource Center (312) 422-2050, rc@aha.org