annals of internal medicine

Healthcare whistleblowers helped get back $9.3B

Anne Zieger — Tue, 02 Sep 2008 11:52:19 -0400

Whistleblowers have helped authorities recover at least $9.3 billion from healthcare providers according to a new analysis of U.S. Department of Justice records. Since the DoJ began working harder to involve insiders in its efforts to fight healthcare fraud, the number of whistleblowers coming forward has increased. Today, whistleblowers initiate more than 90 percent of the DoJ's lawsuits focused on healthcare fraud.

While they may be moved by unhappiness with what they've seen, the fact that they get between 15 and 25 percent of the amount recovered can't hurt either. Of the $9.3 billion recovered between 1996 and 2005, whistleblowers received more than $1 billion, according to analysts writing for the Annals of Internal Medicine.

As large as these numbers are, they're conservative, as information was available only for about three-quarters of the 379 cases reviewed. Also, some of the most spectacular recoveries took place after the review period. For example, the $920 million settlement with Tenet Healthcare took place in 2006. Also, in recent times, there have been large recoveries from pharmas, pushing average settlements from $10 million per case in 2002 to $50 million in 2005 alone.

To learn more about this research:
- read this Associated Press article

Related Articles:
Auditor brings whistleblower suit against FL hospital district
Department of Justice faces 500-case healthcare whistle-blower backlog
DoJ joins whistleblower suit against OH MDs, hospital

Study: Millions of chronically ill not getting care they need

Anne Zieger — Tue, 05 Aug 2008 10:35:42 -0400

A new study confirms what most in the provider arena already knew--that far too many patients with chronic conditions like diabetes or high blood pressure aren't getting the care they need because they lack health insurance. The study, published in the Annals of Internal Medicine, estimates that roughly one of every three uninsured, working-age adults--or about 11 million people--has been diagnosed with a chronic illness. Researchers concluded that many of these patients seldom see primary care doctors, with some relying instead on emergency rooms for their care.

In their survey, researchers found that almost one-quarter of the uninsured with a chronic illness hadn't visited a health professional within the last year, and about 7 percent said they typically went to an emergency room for care. This puts them at high risk for complications, given that, for example, people with high blood pressure can face catastrophic problems like a stroke if they don't get the right drugs or monitoring.

To learn more about the study:
- read this piece in The New York Times

Related Articles:
Study: Uninsured cancer patients die sooner
Chicago hospitals steer uninsured to affordable care
Study: Uninsured ranks could be much lower
EDs seeing more affluent patients, less uninsured

Study: Broad testing can slash MRSA rates

Tue, 18 Mar 2008 07:59:55 -0400

Last week, a study appearing in the Journal of the American Medical Association suggested that screening surgical patients for MRSA isn't particularly effective in blocking the spread of the disease. Now, a new study in the Annals of Internal Medicine has concluded that screening of all hospital patients for MRSA can significantly reduce hospital-acquired infections. While the two might seem to be at odds, some observers say the two studies actually aren't contradictory. The message, researchers say, is that it's not enough to test just high-risk groups; it's critical to test your entire population if you really want to slow progression of the disease, they suggest.

The recent study, done at Evanston Northwestern, began by determining that bout 8.5 percent of all patients had the bacteria on their bodies. The researchers then began testing all patients being admitted to the ICU for the presence of MRSA, the placed them in isolation with special precautions to avoid the spread of disease. (This is what the state of Illinois requires all hospitals to do.) As it happened, however, this did nothing to cut Evanston's MRSA rates. However, in 2005, Evanston began testing all patients for MRSA. At that point, hospital-acquired MRSA rates dropped 70 percent.

This is a strong argument for instituting state or even federal rules requiring universal MRSA testing, don't you think?

To learn more about the new research:
- read this Chicago Tribune piece

Related Articles:
Study: MRSA testing may not help. Report
Case study: NY hospital isolates MRSA patients. Report
Case study: NC hospital cuts MRSA rates. Report
VA program slashes MRSA infection rates. Report
Study: Disinfectant cuts down on MRSA. Report

Study: Math mistakes can cause big med problems

Wed, 23 Jan 2008 06:59:54 -0500

A new study underscores that simple math errors by physicians can prove deadly when it comes to medications. In the study, which appeared in the Annals of Internal Medicine, researchers asked physician volunteers to give a hypothetical 5-year-old suffering from an allergic reaction 0.12 milligrams dose of epinephrine. Half the 28 volunteer doctors were given a bottle labeled "1 milligram in a 1 milliliter solution," while the others got bottles labeled "1 milliliter of a 1:1000 solution," both of which amount to the same thing. While 11 of the first 14 doctors got the math right, only 2 in the second group did, and one doctor in the second group administered what would have been eight times the correct amount. The study underscores that errors in converting from milligrams per milliliter could lead to errors by factors of 10, which can be very dangerous, researchers noted.

To learn more about the study:
- read this piece in The New York Times

Unclear on how hospital data affects decisions

Tue, 15 Jan 2008 06:59:56 -0500

While public policy is very much in favor of providing detailed data on hospital performance and quality, there's little evidence to suggest that this data actually affects patient decisions, according to a new study published in the Annals of Internal Medicine. While many states have established public reporting systems which require hospitals to disclose data such as infection rates or mortality levels, there's not much in the academic literature to back up claims that it affects consumer decision-making. What's more, what literature does exist suggests that consumers find report cards to be confusing rather than helpful. Researchers say that more research is needed on how reporting systems should be designed before public policymakers can have an impact on consumer health decision-making.

To find out more about the study:
- read this Modern Healthcare article (reg. req.)

Related Articles:
A failing grade for report cards? Report
California officials plan PPO 'report card.' Report
CO publishes hospital quality report card. Report
MN quality ratings find wide performance gaps. Report
OH hospitals debate quality ratings. Report
Maryland unveils hospital guide. Report

Study: Digital mammography not as cost-effective as thought

Fri, 04 Jan 2008 06:59:54 -0500

Digital mammography may be an amazing tool, but it's only cost-effective to use it with younger women or women with dense breasts, according to a new article appearing in the Annals of Internal Medicine. The study, which involved more than 42,000 women in the U.S. and Canada, was done as part of the Digital Mammography Imaging Screening Trial done through the American College of Radiology Imaging Network. According to the study, conventional film mammography appeared to do a better job for older women with nondense breasts (though the results were not statistically significant). Researchers concluded that for some groups of women, the results of using more-expensive digital mammography technology didn't justify the added costs.

To find out more about the study:
- read this Medical News Today piece
- read the Annals abstract

Related Article:
Digital mammography doesn't improve detection rates. Report

Study: Doctors may not report peer mistakes

Tue, 04 Dec 2007 06:59:56 -0500

New research suggests that many doctors don't report fellow physicians for medical errors or even a lack of skills. The study, which appeared in the Annals of Internal Medicine, found that 45 percent of 1,662 physicians surveyed didn't always report impaired or unskilled physicians in their practices. At the same time, 46 percent had failed to report a serious medical error to authorities at least once. Despite their comparatively low reporting rate, nearly all of the physicians (93 percent) said that they felt errors should be reported to the appropriate authorities. Meanwhile, 96 percent thought doctors should report on impaired or incompetent peers. This study gives weight to charges that physicians aren't doing a great job of policing themselves, the authors said.

To learn more about the study:
- read this Modern Healthcare piece

Related Articles:
Study: Medical errors stress physicians. Report
Study: Doctors avoid medical error disclosures. Report
Lawmakers want study of physician hours, error rates. Report

Study: Limiting intern hours improves patient care

Mon, 18 Jun 2007 20:01:35 -0400

Evidence is piling up, in study after study, that it just makes sense to limit work shifts for residents and interns. In today's example, which comes from the Annals of Internal Medicine, researchers at Yale-New Haven Hospital collected data on treatment and outcomes before and after work limits were imposed. Researchers looked at patient length of stay, 30-day readmission rates and medical errors for both teaching services, where work-hour limits were imposed, and compared them with nonteaching services where conditions remained the same. Within the teaching services, transfers to the ICU, adjusted death rates and medication errors fell, while discharges to home or rehab rose. The authors note that the study was limited to one hospital and not randomized, which could affect the outcome. Still, it is a result hospital administrators and physician leaders should take seriously.

To learn more about the study:
- read this report in The New York Times (reg. req.)
- review the Annals study

Study:Lower pay threatens PCP supply

Tue, 20 Feb 2007 19:01:37 -0500

The number of U.S. medical students choosing primary care work is falling like a stone, largely because primary care doctors make so much less than specialists do, according to a new study by the University of California, San Francisco (UCSF). The study offers a similar cautionary note as a PCP study released last year by the American College of Physicians (ACP). The ACP found that the number of internal medicine trainees planning on PCP work fell from 54 percent in 1998 to 25 percent in 2004.

Among the conclusions of the UCSF study, which was published yesterday in the Annals of Internal Medicine, was that specialists are earning almost twice as much as PCPs, even if they work the same number of hours. The gap is largely caused, surprisingly enough, by health plans. Despite their frugality, health plans often pay specialists doing routine procedures two-and-a-half to three times the amount a PCP would get to treat a complicated patient. The result is an "impending crisis" in access to primary care, said study lead author Thomas Bodenheimer, M.D., MPH, a UCSF professor of family and community medicine.

To learn more about the study results:
- read this piece in the San Francisco Business Times

Related Articles:
Report: Primary care MD pay rose 3.9 percent in 2005. Report
Study examines primary care doc satisfaction. Report

Study: Patients confused by medication labels

Mon, 11 Dec 2006 19:01:35 -0500

Doctors, maybe it's worth spending a few extra moments telling patients how they should take their medicines. According to a study which will be published next week in the Annals of Internal Medicine, patients with inadequate reading skills often make mistakes with their drugs because they have trouble reading prescription labels. At greatest risk are people with below sixth-grade literacy levels and people with multiple prescriptions to manage, researchers concluded. To conduct the study, researchers interviewed 395 English-speaking adults who were waiting in clinics to see their doctors. They found that when patients made mistakes in interpreting prescription labels, 52 percent of the mistakes concerned dosing levels. Also, they noted that less than 10 percent of patients paid attention to warning stickers such as "may cause drowsiness" which appear on prescription bottles.

Learn more about the study:
- read this USA Today piece