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READMISSIONS: Diabetics with low blood sugar on last day of inpatient hospital stay are more likely to be readmitted

Potential approaches that may reduce the risk for readmission or death after discharge [for diabetes patients] include delaying patient release from the hospital until normoglycemia is achieved, modifying outpatient [diabetes] medications or advise patients to perform frequent glucose monitoring or use continuous glucose-monitoring devices.”

The relationship between low blood glucose levels and hospital readmission was studied in this large-scale analysis of over 800,000 admissions to Veteran Affairs hospitals over a period of 14 years. An inverse relationship was found – diabetic patients with low blood glucose levels (hypoglycemia) on the last day of a hospital inpatient stay were more likely to be readmitted to the hospital or to die within 180 days after discharge.

Source: Spanakis, E.K., and others. (2019, September). Association of glucose concentrations at hospital discharge with readmissions and mortality: A nationwide cohort study. JCEM. The Journal of Clinical Endocrinology & Metabolism, 104(9), 3679-3691. Click here for free full text:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6642668/?report=printable  Posted by AHA Resource Center, (312) 422-2003, rc@aha.org




LEADERSHIP: Examples of dual-CEO model

Dual-CEO models can work as a ‘bridge to completing a deal’ between health systems that might otherwise be skeptical of a merger, and it can be a ‘potentially successful short-term solution…’ [Daily Briefing, March 20, 2019]

In some mergers, consolidation of the legacy organizations results in creating a dual-CEO or co-CEO or co-President position.  This was true for Jim Skogsbergh (legacy Advocate with sites in Illinois) and Dr. Nick Turkal (legacy Aurora with sites in Wisconsin) in the 2018 merger that created the not-for-profit system Advocate Aurora Health.  It has just been announced that Dr. Turkal, who had been overseeing the Wisconsin organization, will be leaving.  Other examples of the dual-CEO model are described in The Modern Healthcare article (Kacik, 2019), which is summarized in the Daily Briefing post.

Sources: Porter, S. (2019, July 24). Advocate Aurora Health ditches dual CEO model, picks Jim Skogsbergh. HealthLeaders. Click here:  https://www.healthleadersmedia.com/strategy/advocate-aurora-health-ditches-dual-ceo-model-picks-jim-skogsbergh

Kacik, A. (2019, March 9). Dual-CEO model requires a delicate, short-term approach. Modern Healthcare. Click here:  https://www.modernhealthcare.com/providers/dual-ceo-model-requires-delicate-short-term-approach

Are 2 CEOs better than one? Why some health systems are embracing the dual-CEO model. (2019, March 20). Daily Briefing [Advisory Board]. Click here;  https://www.advisory.com/daily-briefing/2019/03/20/co-ceos

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

ACCOUNTABLE CARE ORGANIZATIONS: It is cost effective to have specialists see patients, up to a point

Some specialist involvement in care processes for patients appears to be necessary for accountable care organizations to lower their costs.”

Health care spending in accountable care organizations (ACOs) was studied based on the percent of patient visits which were provided by specialists.  Data from 620 ACOs for the period April 2012 through September 2017 were analyzed.  It was found that ACOs in which specialists provided 40 to 45 percent of office visits had the lowest expenditures.  ACOs at either extreme – the fewest or the most specialist encounters – had the highest expenditure rates.

Source: Shetty, V.A., Balzer, L.B., Geissler, K.H., and Chin, D.L. (2019, July 10). Association between specialist office visits and health expenditures in accountable care organizations. JAMA Network Open, 2(7).  Click here for free full text:  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2737841  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

Drug Discount: Characteristics of Hospitals Participating and Not Participating in the 340B Program

The U.S. Government Accountability Office (GAO) released a report on the results of the study that analyzes the characteristics of hospitals that participate or do not participate in the 340B drug discount program. The GAO conducted this study due to the sixty percent increase from 2011 to 2016 in program participation, as well as the impact of Medicaid expansion on 340B participation.

The study was focused on three of the six hospital types, as they accounted for ninety five percent of U.S. hospitals participating in the 340B program. These three hospital types include:

  • Critical Access Hospitals (CAH)
  • Sole Community Hospitals (SCH)
  • General Acute Care Hospitals (Also Known As 340B DSH)

The full report can be found on the U.S. Government Accountability Office website, https://www.gao.gov/products/GAO-18-521R.

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

MORTALITY TRENDS: Heart disease still leading cause of death but cancer is catching up

Heart disease is the leading cause of death in the U.S. and has been for decades.  In 2014, there were more than 614,000 deaths from heart disease.  However, a look at the long term trend lines shows that the number of deaths from heart disease is a curve that went up in the 70s and 80s  and then has been coming back down in more recent years.  The inflection point was 1985 with over 770,000 deaths from heart disease.

Cancer deaths meanwhile have been steadily increasing in a more or less straight line fashion from about 210,000 in 1950 to nearly 600,000 in 2014.  Cancer is the second leading cause of death and has now nearly caught up with heart disease.

As of the most recent year, 2014, there were 22 states in which cancer deaths have surpassed heart disease deaths.  The statisticians who wrote this brief note that the “leading-cause crossover” between heart disease and cancer was expected for the nation as a whole sometime around 2010, but that there was an uptick in heart disease mortality that kept this from happening at that time.

Source: Heron, M., and Anderson, R.N. (2016, Aug.). Changes in the leading cause of death: Recent patterns in heart disease and cancer mortality. NCHS Data Brief, 254.  Click here for free full text: http://www.cdc.gov/nchs/data/databriefs/db254.pdf   Also, data tables here: http://www.cdc.gov/nchs/data/databriefs/db254_table.pdf#1  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

COMPENSATION: Most nurse managers in this survey earned $80,000 to $120,000 in 2015

The American Organization of Nurse Executives (AONE) has released the executive summary of a more comprehensive report scheduled to come out by early August 2016 on nurse leader compensation.  These data represent compensation for calendar year 2015.  The compensation data are reported for different job titles and for different types of employers.  Here are some of the findings:

  • There were usable responses from 481 nurse managers
  • Two-thirds of the nurse managers reported 2015 base salary between $80,000 and $120,000
  • There were usable responses from 90 chief nursing officers (CNOs) of health systems
  • Two-thirds of these CNOs reported 2015 base salary of $210,000 or more
  • Half of the system CNOs reported 2015 base salary of $250,000 or more

Source: American Organization of Nurse Executives. (2016). Salary and compensation study for nurse leaders. Chicago: AONE.  Click here:  http://www.aone.org/docs/resources/nurse-leader-salary-summary.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Apple Watch and Hospitals Using It in the News

The new Apple Watch has been in the news this week, but so have several hospitals that are using it with patients. Apple’s HealthKit mobile app is available with its Watch.

Cedars-Sinai Medical Center has linked its electronic medical records system to Apple’s HealthKit software, giving patients the option for adding their data to their health records. Ochsner Health System will be using the Apple Watch to manage hypertension in patients initially, but may add other patients with chronic diseases.

Mayo Clinic, Stanford University Hospital, and Duke University Hospital are also among the first hospitals or health systems connected to HealthKit system. Reuters news service has reported that 14 of 23 major hospitals it contacted have pilot programs using Apple’s HealthKit mobile software. Competitive services from Google and Samsung have also begun reaching out to some hospitals and others in the medical field..


Stempniak M. New Orleans Health System harnesses Apple Watch to manage chronic disease. H&HN Daily, April 27, 2015. http://www.hhnmag.com/display/HHN-news-article.dhtml?dcrPath=/templatedata/HF_Common/NewsArticle/data/HHN/Daily/2015/April/Oschsner-Health-Apple-Watch-chronic-disease-blog-stempniak

Bowman D. Cedars-Sinai goes all-in on Apple HealthKit. FierceHealthIT.com, April 27, 2015. http://www.fiercehealthit.com/story/cedars-sinai-goes-all-apple-healthkit/2015-04-27

Comstock J. Apple Watch already has 264 health apps, unused pulse ox functionality, and a hospital pilot. MobiHealthNews.com, April 27, 2015. http://mobihealthnews.com/42900/apple-watch-already-has-264-apps-unused-pulse-ox-functionality-and-a-hospital-pilot/

Higgins T. Apple’s HealthKit linked to patients at big Los Angeles hospital. BloombergBusiness, April 26, 2015. http://www.bloomberg.com/news/articles/2015-04-26/apple-s-healthkit-linked-to-patients-at-big-los-angeles-hospital

Diamond D. A hospital is already giving Apple Watch to its patients. Forbes.com, April 24, 2015. http://www.forbes.com/sites/dandiamond/2015/04/24/can-apple-watch-make-patients-healthier-how-one-hospital-is-trying-to-find-out/

Farr C. Exclusive: Apple’s health tech takes early lead among top hospitals. Reuters, Feb. 5, 2015. http://www.reuters.com/article/2015/02/05/us-apple-hospitals-exclusive-idUSKBN0L90G920150205

Dvorak K. mHealth Summit 2014: HealthKit, EHR pilot programs show great promise, execs say. FierceMobileHealthcare.com, Dec. 20, 2014. http://www.fiercemobilehealthcare.com/story/mhealth-summit-2014-healthkit-ehr-pilot-programs-show-great-promise-execs-s/2014-12-10

Goldstein P. Apple moves into mobile healthcare with HealthKit software. FierceWireless.com, June 2, 2014. http://www.fiercewireless.com/story/apple-moves-mobile-healthcare-healthkit-software/2014-06-02

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

Top 25 Integrated Health Systems – 2013

2014 update now available

Cegedim has ranked the top 25 integrated health systems based on the total number of facilities. Ascension Health tops the list, followed by Kaiser Permanente and HCA. The ranking lists the number of hospitals, medical offices and groups, nursing homes, and total physicians affiliated with each system.

In addition to most facilities overall, Ascension Health also has the most medical offices and groups and most nursing homes. Kaiser Permanente has the most affiliated physicians, and HCA has the most hospitals.

Source: Top 25 integrated health systems. SK&A, a Cegedim company, Sept. 2013. http://www.skainfo.com/registration_OneKey.php [free registration required to view/download]

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

Volunteering in the U.S. – 64.5 million points of light

In his 1989 inaugural address, George H. W. Bush invited Americans to volunteer – to become one of a “thousand points of light”.  America was listening! According to data from the U.S. Bureau of Labor Statistics, there were 64.5 million volunteers who provided service at least once between September 2011 and September 2012. Most volunteers put in time through a religious or education/youth service organization; however, 7.8% – or approximately 5 million individuals – provided service in a hospital or health care setting.

The report, available online, provides a number of statistical analyses:

  • Demographics: age, gender, race/ethnic group, educational attainment, marital status, employment status, parents of children under the age of 18 (it makes a difference!)
  • Hours of volunteer service provided: almost 6% of all volunteers reported 500+ hours of service in the year; the median was 50 hours
  • Number of organizations for which one volunteers
  • Type of primary organization for which one volunteers: civic/political/professional/international, educational/youth service, environmental/animal care, hospital/health care, public safety, religious, social/community service, sport/hobby/cultural/arts, other 
  • Main volunteer activity: the greatest number (10.9%) collected, prepared, distributed, or served food
  • How volunteers become involved: self-directed, asked by someone else (boss, relative/friend/co-worker, someone in the organization, etc.)

The summary portion of the report also includes historical data back to September 2008.

Source: U.S. Bureau of Labor Statistics.  Volunteering in the United States – 2012.  [press release]  February 22, 2013.  http://www.bls.gov/news.release/pdf/volun.pdf   Earlier reports (back to 2002) are available at http://www.bls.gov/schedule/archives/all_nr.htm#VOLUN.

POPULATION HEALTH: Catholic Health Initiatives’ pilot

Catholic Health Initiatives (Denver) http://www.catholichealthinit.org/, a large multi-institutional system, is working on managing population health based on the accountable care organization (ACO) model.  The target population is CHI employees.  The model is also structured on the medical home approach.  CHI hopes to cut employee health care costs by 10 to 14 percent. 

Why I like this article: At the end, there are suggestions on how other health systems might begin to approach population health management.

Source: Sanford, K.D.  Population health management: a “start small” strategy.  Healthcare Financial Management;67(1):44-47, Jan. 2013.  Click here for more information: http://insurancenewsnet.com/article.aspx?id=370913&type=newswires  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org