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READMISSIONS: Hospital revisits data trends including emergency department visits and observation visits

Although readmissions for target conditions decreased from 2012 to 2015 in the US, total hospital revisits within 30 days of discharge steadily increased over that same period.”

Changes in total 30-day hospital revisits (including emergency department treat-and-discharge visits and observation stays as well as hospital readmissions) were studied for Medicare patients hospitalized with pneumonia, heart failure or acute myocardial infarction from January 2012 to September 2015.  A total of over 3 million original hospitalizations were studied.  Hospital readmissions decreased over the study period, but treat-and-discharge visits and observation stays increased.

Source: Wadhera, R.K., and others. (2019). Hospital revisits within 30 days after discharge for medical conditions targeted by the Hospital Readmissions Reduction Program in the United States: National retrospective analysis. BMJ. 366.  Click here for free full text:https://www.bmj.com/content/bmj/366/bmj.l4563.full.pdf  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

PARKINSON’S: Integrated practice unit (IPU) offers one-stop-shop model of care

The concept of an integrated practice unit (IPU) would offer patients with the same disease – Parkinson’s is explored in this article but the model has broader applicability – a team of specialists with appropriate resources at hand for the care of a complex chronic condition.  Several case examples of providers who are developing this type of care include:

  • ParkinsonNet in The Netherlands
  • Kaiser Permanente
  • Van Andel Research Institute (Grand Rapids, MI) – based on the ParkinsonNet model
  • Cleveland Clinic

The author identifies two components as critical for an IPU: patient-reported outcome measures and focus on value.

Sources: McKee, K. (2019, August 1). Creating “one-stop shop” care for Parkinson’s. NEJM Catalyst. Click here: https://catalyst.nejm.org/one-stop-shop-care-parkinsons/

Kaiser Permanente. Our care model.  Click here:  https://parkinsonscare.kaiserpermanente.org/our-care-model/

Van Andel Institute and ParkinsonNet explore partnership. (2015, June 2). News Release.  Click here: http://www.parkinsonnet.info/news/van-andel-institute-and-parkinsonnet-explore-partnership

Porter, M.E., Teisberg, E.O. (2019, June). Cleveland Clinic: Transformation and growth 2015. HBS Case Collection. Click here:  https://www.hbs.edu/faculty/Pages/item.aspx?num=36929  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

PHYSICIANS: Cardiovascular surgeons and invasive cardiologists generate the most revenue

The amount of revenue generated by different specialties for the hospitals where they practice is analyzed every three years by Merritt Hawkins, a physician recruiting firm.  New data for 2019 edition show the following specialties to be the highest in revenue generation (these figures are rounded):

  • $3.7 million: Cardiovascular Surgery
  • $3.5 million: Invasive Cardiology
  • $3.4 million: Neurosurgery
  • $3.3 million: Orthopedic surgery
  • $3 million: Gastroenterology

Primary care physicians, as a group, generated about $2.1 million each for their hospitals.  There is also a cost/benefit analysis in this report, which compares the average revenue generated with the average salary for each specialty.

Source: Merritt Hawkins. (2019). 2019 physician inpatient/outpatient revenue survey.  Click here: https://www.merritthawkins.com/uploadedFiles/MerrittHawkins_RevenueSurvey_2019.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

VALUE: Americans are lousy patients

Could the problem with America’s health-care system lie not only with the American system but with American patients?”

Americans do not take prescribed medications.  We make poor lifestyle choices.  We demand expensive tests and scans and procedures.  All of these factors contribute to making the American health care system costly while failing to produce very good outcomes, compared to other developed nations.

Source: Freedman, D.H. (2019, July). The worst patients in the world. The Atlantic, 324(1), 28-30.  Click here for text: https://www.theatlantic.com/magazine/archive/2019/07/american-health-care-spending/590623/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

PEDIATRICS: Kangaroo mother care for preterm infants in neonatal intensive care units

To improve the NICU experience for mothers and promote the health of preterm infants, social supports, such as improved maternity leave policies and reliable hospital access through child care, accommodation, and transportation supports are required, even for parents with insurance coverage.”

This is a small study based on interviews with 20 mothers who gave birth to preterm infants in 2016 at Tufts Medical Center (Boston).  The objective was to evaluate how these mothers of infants in the neonatal intensive care unit viewed the practice of kangaroo mother care – which involves skin-to-skin contact and frequent breast feeding.  Barriers to use of this practice are explored.

Source: Lewis, T.P., Andrews, K.G., Shenberger, E., and others. (2019). Caregiving can be costly: A qualitative study of barriers and facilitators to conducting kangaroo mother care in a US tertiary hospital neonatal intensive care unit. BMC Pregnancy and Childbirth, 19:227. Click here for free full text:     https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2363-y#Abs1  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

DISRUPTORS: Redesigning patient care in a ‘facilitated self-service’ model – the bot, the nurse, the PCP

Facilitated self-service means consumers can handle most of their needs without help, but some needs require a higher level of service.

How to redesign care at the physician office visit level is discussed in this brief perspective.  In the facilitated self-service model, patients might first encounter a bot for routine check-ups of chronic conditions.  The second level of care would be the nurse and the third level, the physician, if needed.  The authors maintain that this radically different approach would be better than trying to expand the numbers and availability of primary care physicians for routine care.

Source: Asch, D.A., Nicholson, S., and Berger, M.L. (2019, May 16). Toward facilitated self-service in health care.  New England Journal of Medicine, 380(20), 1891-1893.  Click here for full text (you can sign up as a visitor for 3 full text articles per month):  https://www.nejm.org/toc/nejm/medical-journal?query=main_nav_lgPosted by AHA Resource Center (312) 422-2050 rc@aha.org