June 2010

Healthcare Topics and Trends Update

CHRT's monthly online newsletter, providing convenient access to recently-published articles relating to healthcare quality, sustainability and access.

Past Issues »

Cardiology

Trends in Length of Stay and Short-term Outcomes Among Medicare Patients Hospitalized for Heart Failure, 1993-2006

The Journal of the American Medical Association, June 2, 2010

According to this study, during the last decade, the most prominent change in the acute care of patients with heart failure (HF) was a decreasing length of stay in hospitals. This researchers found that the decreases in length of stay are significantly associated with 30-day readmission rates. Although the 30-day mortality rate has decreased, this increase in the readmission rates that paralleled the decrease in length of stay raises concerns—as does the increase in the rates of discharge to nursing home facilities. The study indicates that care for older patients with heart failure can be improved with routine surveillance and the monitoring of care and outcomes in the early transition period after hospital discharge.

Health Care Reform

Evidence That Consumers Are Skeptical About Evidence-Based Health Care

Health Affairs, June 3, 2010

Passage of the Patient Protection and Affordable Care Act of 2010 has laid the groundwork for major reforms, including greater use of evidence-based medicine, shared decision making, comparative effectiveness research, evidence-based benefit design, and transparency of cost and quality information. This study found that most consumers hold misconceptions about evidence-based health care and what these terms imply. Few consumers understood terms such as "medical evidence" or "quality guidelines." Most believed that more care meant higher-quality, better care. The gaps in knowledge and misconceptions point to serious challenges in engaging consumers in evidence-based decision making. As Michigan implements the Affordable Care Act, local business leaders and key stakeholders should consider significant investments in communication efforts that facilitate the adoption of evidence-based care.

Patient Centered Medical Home

Medical Home Capabilities of Primary Care Practices That Serve Socio-demographically Vulnerable Neighborhoods

Archives of Internal Medicine, June 14, 2010

This study assessed 308 primary care facilities according to 13 structural measures included in medical home proposals. Using U.S. census data, practices serving disadvantaged neighborhoods were identified and their structural capabilities were compared to other practices. Researchers found that primary care practices that served socio-demographically vulnerable neighborhoods were more likely to align with the goals of medical home proposals. Such structural measures included: Staff assisting in patient self-management, on-site language interpreters, multilingual clinicians, and multifunctional electronic health records systems. The findings suggest that payments tied to these services could aid primary care facilities serving vulnerable populations.

Safety Net

Free Clinics in the US: A Nationwide Survey

Archives of Internal Medicine, June 14, 2010

This study examined the attributes of free clinics and measured their contribution to the safety net. The main outcome measures were organizational structures, operations, revenue sources, patient profiles, services, and staffing. The survey collected data from 1007 free clinics in 49 states and the District of Columbia. The results showed that free clinics provided care for 1.8 million people, accounting for 3.5 million medical and dental visits a year. The mean free clinic budget was $287,810. However, 58.7% of free clinics received no government revenue. On average, free clinics were only open 18 hours per week, and they usually provided chronic disease management (73.2%), physical examinations (81.4%), urgent/acute care (62.3%), and medications (86.5%). Free clinics operate largely outside of the safety net system. However, they have become an established and meaningful contributor to it. The authors conclude that policymakers should consider integrating the free clinic network with other safety net providers or providing direct financial support.

Triple Aim

Effect of Hospital Follow-up Appointment on Clinical Event Outcomes and Mortality

Archives of Internal Medicine, June 14, 2010

Although research has demonstrated a correlation between follow-up arrangements and reduced hospital readmission in specific patient populations, the effect of hospital follow-up in general medicine patients has not been assessed until now. This study reviewed hospital dismissal instructions for general medicine patients discharged in 2006 from Mayo Clinic hospitals in Rochester, Minnesota, and determined whether or not a follow-up appointment was scheduled. Survival analysis and regression models were developed to investigate the association between follow-up appointments and hospital readmission, emergency department visits, and mortality at 30 and 180 days after discharge. Surprisingly, the study concluded that improved discharge processes, such as follow-up appointments, do not appear to improve readmission rates or survival in general medicine patients.

Making the Value Proposition in Benefit Design

Changes in Health Care Financing and Organization, June 2010

The value-based insurance design (VBID) structures health insurance benefits in a way that is intended to lower costs, enhance care, and improve the health of populations. VBID lowers or eliminates financial barriers to purchasing ‘high-value’ drugs and services. This article summarizes VBID: Appreciating the heterogeneity of cases, insurers using the VBID approach define ‘high-value’ relative to four specific criteria: Services, conditions, condition severity, and disease management participation. Copayments are waived or reduced for select evidence-based services and the treatment of certain conditions. The design also takes the patient into account; copayments are waived or reduced for services that keep high-risk patients healthy. Likewise, financial barriers are removed for participation in disease management programs that have attained performance standards established by the insurer. The article contends that while the VBID approach offers promise, it also requires further investment in comparative effectiveness and evidence-based research.