death rates

New study questions benefits of $10 billion angioplasty industry

Anne Zieger — Tue, 18 Nov 2008 10:16:18 -0500

Over recent months we've seen several studies that questioned the benefit of angioplasty in many of the cases in which it is used; with the number of angioplasties performed per year having increased to almost 800,000, however, it's worth revisiting.

The procedure costs nearly $12,000, results in a week in the hospital, and may not even be particularly effective in many of the cases it is used. When patients who are having chest pain but not an actual heart attack have an angioplasty, their pain often comes back within six months to a year after the procedure.

With drugs that can relieve the chest pain less expensively and with less risk, why do doctors give them angioplasties? Oftentimes, doctors simply don't do a thorough enough evaluation of the patient, new studies indicate. Also, patients sometimes think that an angioplasty is much more important to their survival than it actually is.

The newest study, called Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation, or COURAGE, followed over 2,000 patients at hospitals around the country with stable heart disease. It found that there was no significant difference in rates of death, heart attack, or stroke between patients who had medical therapy alone or those who had an angioplasty.

To learn more about the study:
- read this Kansas City Star article

CMS posts death rate estimates for hospitals

Anne Zieger — Thu, 21 Aug 2008 00:04:48 -0400

For a long time, hospital-specific death rates were secrets. Administrators argued that publishing such rates was unfair, as it would be easy to make unfair comparisons if rates weren't adjusted properly for acuity. That being said, CMS has essentially taken things out of their hands. The agency has made estimates by specific hospital and posted that information on its quality website, hospitalcompare.hhs.gov.

The data offers comparisons of performance on more than two dozen measures, including death rates for pneumonia, heart attacks and heart failure. The formula used to calculate death rates captures all deaths among 35 million Medicare beneficiaries occurring within 30 days of the patients' hospital admission. The formula took into account the hospital's patient mix and how many deaths would be expected in those populations.

While the data is more specific than it has been in the past, it's still using somewhat conservative measures, critics say. The death rate scoring ends up rating the majority of hospitals as average, which doesn't do much to guide employers or consumers in their health purchasing decisions. However, the new measures have little to complain about, others say.

To learn more about the ratings:
- read this USA Today article

Related Articles:
CMS to publish cardiac death rates, but carefully
MA officials question high hospital death rates
CMS to post hospital heart attack care data

Study: Admission day dictates heart failure, length of stay

Thu, 22 May 2008 06:59:55 -0400

A new study suggests that heart failure patients admitted to the hospital on Thursdays and Fridays have longer stays in the hospital than those admitted on other days of the week, while those admitted on Tuesday have the shortest stays. Generally speaking, there were far fewer discharges over the weekends, particularly on Sundays, noted Dr. Gregg Fonarow, professor of cardiovascular medicine at the University of California, Los Angeles, David Geffen School of Medicine. Interestingly, there was no relationship between the day admitted and death rates, though heart attack patients admitted on weekends were more likely to die than those admitted on weekdays.

To conduct the study, Fonarow and his colleagues looked at data from a sample of 48,612 heart failure patients admitted to 259 hospitals across the U.S. They found that hospital lengths of stay differed from 5.39 days for those admitted on Tuesdays to 5.88 days for those admitted on Fridays.

To learn more about the study:
- read this HealthDay News item

Related Articles:
Study: Remote monitoring improves heart failure outcomes
CMS to publish cardiac death rates, but carefully
Hospital heart attack deaths plummet
Study: Nurse-driven heart failure support boosts compliance

C. diff threat growing across the U.S.

Mon, 05 May 2008 06:59:56 -0400

Clostridium difficile has long been known to providers as a common but easily-treated bug whose symptoms aren't a big deal. However, of late a drug-resistant strain of C. diff has become more common, posing far greater risks to patients. In fact, some health officials now rank C. diff on par with MRSA as a top infection acquired in hospitals. And it's tough to fight; typical germicides and alcohol sanitizers don't kill it, nor does routine cleaning of surfaces.

Overall C. diff infections in the U.S. have more than doubled since 2000. The NAP1 type of the bacteria, which produces 20 times the toxins of a more benign form, can cause devastating symptoms that can sometimes be lethal. In 2005, almost 10 percent of the patients who were diagnosed as having the bug died. However, some officials think the infection and death rates from C. diff may be much higher, as providers currently aren't required to report the presence of the bug.

To learn more about C. diff's spread:
- read this MSNBC.com article

Related Articles:
Study: C. diff infections, deaths up in hospitals
CDC warns C. diff a threat for hospitals
MDs, hospitals face tough C. diff battle
C. diff deaths shoot up in Ohio

GA minorities suffer big health disparities

Mon, 21 Apr 2008 06:59:55 -0400

A new report concludes that Georgia's minorities suffer significantly worse health than non-minority citizens, with the report awarding an "F" to 16 Georgia counties on scores of minority care. The grades, which were issued by the state's Department of Community Health, reflect the serious differences found in death rates before age 75. (Another report, by the United health Foundation, ranked Georgia 40th in health status overall, with African-Americans there experiencing 44 percent more premature deaths than whites.)

The disparities come, in part, from structural problems faced by the state's healthcare system as a whole. Of the state's 159 counties, 118 are rural, and have roughly half as many doctors per capita as, say, metro Atlanta, in addition to major shortages of nurses, therapists and nutritionists, the report said. However, minorities generally seem to face bigger obstacles to getting care than non-minority citizens.

To learn more about Georgia's health disparities:
- read this Atlanta Journal-Constitution article
- read this Community Health press release

Related Articles:
Racial disparities persist in health outcomes
Study: 'Medical homes' cut racial care disparities
Study: Hispanics get lower-quality medical care
CMS hopes to close Medicare race, ethnicity gap

Study: Older blacks less likely to get cancer treatments

Tue, 08 Jan 2008 06:59:54 -0500

Black patients older than 65 are "consistently less likely" than comparable white patients to receive recommended cancer treatments, according to a new study published in the journal Cancer. The study, which examined treatments for more than 143,000 U.S. residents with lung, breast, colon, rectal or prostate cancer treated between 1992 and 2002 under Medicare, revealed some marked differences in the treatment of lung, colon and rectal cancers.

Among various disparities, researchers found that blacks with early-stage lung cancer were 19 percent less likely to have tumors surgically removed than whites. Blacks with rectal cancer were 27 percent less likely than whites to get chemotherapy after having tumor-removal surgery, and blacks with colon cancer were 24 percent less likely to get chemotherapy than whites after surgical removal of a tumor.

To learn more about the study:
- read this Kaiser Daily Health Policy Report piece

Related Articles:
Trend: States look for social roots of ethnic health disparities. Report
Study: California death rates vary by race. Report
Medical homes cut racial care disparities. Report
Racial disparities persist in health outcomes. Report
Medicare should help fix disparities. Report
Researchers fight for ethnic diversity in trials. Report
San Francisco tracks biggest killers of its ethnic groups. Article

OR provides case study for consumer-driven care

Mon, 07 Jan 2008 06:59:55 -0500

In Oregon, consumers are getting just about as much data on healthcare providers as anyone in the country. Not only is the state reporting detailed hospital price comparisons, hospital-specific death rates and infection rates, ten of the state's health plans are driving an effort to report on physician performance. Still, it's going to take a while to get consumers interested and on board, says Regence BlueCross BlueShield vice president. "I think it's going to be a number of years," he says.

Why is consumer use of health data so slow to happen in Oregon? Well, the same reason as in other states, observers say: publicly-reported performance ratings are still crude, and they may or may not even be providing consumers with the information they want. Meanwhile, commercial ratings may offer contradictory results, adding more confusion to the mix. Add that to the fact that patients prefer to make healthcare choices based on personal references and physician referrals, and the picture for data-driven healthcare shopping looks doubtful.

Given these concerns, it seems we've got a long way to go nationally--not just in Oregon--before we can turn consumers into price- and quality-driven shoppers who compare hospitals and doctors like cars and refrigerators.

To find out more about Oregon's situation:
- read this article from The Oregonian

Related Articles:
Transparency goes mainstream. Report
Reassessing healthcare transparency. Report
Consumers reluctant to use outcomes, cost data. Report
Pricing issues make CDHPs problematic. Report

Defibrillator use delays common, harmful

Thu, 03 Jan 2008 06:59:54 -0500

Too often, hospital patients with ventricular arrhythmias aren't treated with defibrillators soon enough, a problem that may have an impact on their survival, according to a new study published in the New England Journal of Medicine. Researchers found that more than 30 percent of ventricular arrhythmia patients studied waited longer than two minutes, the nationally-recommended interval, to get treated with defibrillators. Death rates among those patients were much higher than those who got defibrillation promptly, with just 22 percent of patients surviving with delayed defibrillation, compared with 39 percent who got it in time. Researchers drew this conclusion after studying the records of 6,789 patients with ventricular arrhythmia-induced cardiac arrest at 369 acute-care hospitals between January 2000 and July 2005.

For more study data:
- read this Modern Healthcare piece (reg. req.)

Related Articles:
Cardio group releases defibrillator guidelines. Report
Hospital heart attack deaths plummet. Report
Program aims to improve heart attack care. Report
Hospital care better for heart disease, pneumonia. Report
Study: More heart attack deaths on weekends. Report
New system cuts heart attack treatment times. Report

Trend: States look for social roots of ethnic health disparities

Tue, 18 Dec 2007 06:59:55 -0500

Of late, states have begun to take a new approach to looking at health status differences between whites and minorities, concerned by data suggesting that minorities face dramatically higher rates of, for example, diabetes and infant mortality.

Rather than relying solely on medical data, they've begun to focus on the socio-economic roots of ethnic health disparities, including problems with transportation problems, poverty and discrimination. State health departments are revamping to look at the effects of everything from the impact of institutional racism and sexism to the prevalence of tobacco advertising.

In Minnesota, for example, health officials have been looking for several years at why infant mortality rates among Native Americans were three times as high as whites in the states. After studying the situation, they worked with community members to look at root causes of such health disparities. The officials then rolled out solutions which community groups thought would work.

To learn more about this trend:
- read this Associated Press piece

Related Articles:
Study: California death rates vary by race. Report
Medical homes cut racial care disparities. Report
Racial disparities persist in health outcomes. Report
Medicare should help fix disparities. Report
Researchers fight for ethnic diversity in trials. Report
San Francisco tracks biggest killers of its ethnic groups. Article

MA officials question high hospital death rates

Thu, 06 Dec 2007 06:59:55 -0500

Despite the state's overall reputation for excellent care--and the presence of high-profile institutions like Beth Israel Deaconess and Massachusetts General--at least one study suggests that patients are dying there at a higher rate than average. According to figures from the Institute for Healthcare Improvement, mortality rates at the state's hospitals were 7 percent higher than the national average, despite the state's low poverty rates and high volume of specialists.

Researchers drew this conclusion using a method known as the Hospital Standardized Mortality Ratio, which measures the number of hospital deaths versus expected deaths. This measure is being challenged by the Massachusetts Hospital Association, which notes that the ratio hasn't been validated by the National Quality Forum and other top quality measurement groups. However, some individual hospitals--including Beth Israel Deaconess Medical Center--are in favor of the measure, and have publicly disclosed their own specific ratios voluntarily.

To find out more about the mortality rate dispute:
- read this article from The Boston Globe

Related Articles:
PwC: Hospital IT can lower death rates. Report
Mortality rates fall, readmissions climb in PA. Report
NYC public hospitals disclose infection, mortality rates. Report
Hospital mortality gaps grow among elderly. Report
Mortality rises, falls with nurse staffing levels. Report