heart failure

Study: Heart pumps frequently used incorrectly

Anne Zieger — Wed, 26 Nov 2008 10:15:23 -0500

A new study of heart pumps, or ventricular assist devices (VADs), has found that while they can save lives, they are sometimes not used appropriately or on the correct patients.

The devices, which are meant to treat heart failure, are used in two major groups. One group needed a VAD to treat chronic heart failure, and the other group had heart failure after a coronary bypass or valve surgery. The study found that 51.6 percent of the chronic heart failure patients were still alive a year after implantation, compared with 30.8 percent of the post-surgical ones. Many of the surgery patients never even made it out of the hospital.

Overall, the researchers found two major factors that lowered the survival rate. In some cases, the devices were implanted in patients that were too sick to survive anyway, and in others, the devices were implanted at a hospital where they didn't have much experience with VADs. Survival rates were much higher at clinics and hospitals where they had a steady flow of patients with VADs.

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

Joint Commission says hospital quality improving

Anne Zieger — Mon, 24 Nov 2008 22:33:52 -0500

A new study from The Joint Commission has concluded that U.S. hospitals have steadily improved the quality of patient care over the past six years. The study, which analyzed National Patient Safety Goal compliance and quality measures on several common treatments and procedures, found some dramatic improvements in the areas it measured.

For example, hospitals in the study provided smoking cessation advice to 98.2 percent of heart attack patients in 2000, compared with 66.6 percent in 2002; they also improved their results in giving this advice to heart failure patients and patients with pneumonia. Furthermore, hospitals improved dramatically in providing discharge instructions to heart failure patients (30.9 percent to 77.5 percent) screening and vaccinating pneumonia patients for pneumococcus. Outcome measures improved as well. Heart attack care results, for example, improved to 96 percent in 2007 from 86.9 percent in 2002 on evidence-based measures of care.

Of course, for every positive quality result, there's always some downside. In this case, hospital quality varied widely, and some hospitals did better than others in treating particular conditions. Take heart failure: While hospitals in the highest performing state provided discharge instructions to heart failure patients 92.1 percent of the time, the lowest-performing state's hospitals provided such instructions only 56.6 percent of the time.

To learn more about this study:
- read the report

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CMS awards $7M to top performers in P4P program

Anne Zieger — Wed, 18 Jun 2008 09:11:10 -0400

CMS has announced that it will award a collective $7 million this year to the 112 top performing hospitals in its ongoing pay-for-performance project with Premier. The best performer, Sacred Heart Medical Center in Spokane, Wash., will receive the highest quality incentive payment of $385,342 after getting top ratings in four out of five clinical areas being measured. All hospitals are reporting data on heart attacks and heart failure, coronary artery bypass grafts, pneumonia, and hip and knee replacements.

Officials with the P4P program, which is in its third year, say that there has been substantial and continual improvement among all 250 participating hospitals in 36 states. Hospitals in the CMS/Premier Hospital Quality Incentive Demonstration have raised quality of care by an average of 15.8 percent during the first three years, as evaluated by 30 measures in five clinical areas, CMS officials reported. To date, CMS has awarded $24.5 million in bonuses to top performers in the program.

To learn more about the CMS quality improvement project:
- read this Modern Healthcare article (reg. req.)

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$300M grant from RWJF intended to reduce health disparities

Thu, 05 Jun 2008 06:59:56 -0400

Today the Robert Wood Johnson Foundation is expected to announce a $300 million initiative designed to reduce significant regional and ethnic care disparities across the U.S.--and ultimately, if successful, provide a model for healthcare reform. The study, which will be conducted by researchers at Dartmouth Medical School, will target 14 communities and regions across the country. One major goal of the project is to cut down on hospital admissions for certain conditions. For example, right now, states like West Virginia, Kentucky, Louisiana and Mississippi have high hospitalization rates for problems like poorly-controlled diabetes or worsening heart failure, exceeding 100 discharges per 1,000 beneficiaries. Also, blacks often get worse care than whites; in Memphis, black Medicare beneficiaries are almost six times as likely as whites to have a leg amputated due to vascular disease and diabetes.

To learn more about the initiative:
- read this Seattle Times piece

PLUS: Racial care disparities are widespread among patients with kidney disease, according to a new study. Article

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Consumers Union plans to rate hospitals

Thu, 29 May 2008 06:59:58 -0400

The venerable organization behind the popular Consumer Reports magazine has announced that it's getting into the hospital ratings act. The publisher, Consumers Union, already offers assessments of health-insurance plans, drugs and even some medical treatments, and is considering ratings of physician and elder groups. Its planned hospital ratings are the first step in a program to expand its healthcare ratings services.

Consumer Reports will rate about 3,000 facilities, and will include graphs showing ratings of care intensity and quality of care for nine serious conditions such as cancer and heart failure during the last two years of life. It also will include features reflecting average out-of-pocket costs for physician visits during the last two years of life for the nine conditions. The data will be drawn from the Dartmouth Atlas Project.

To learn more about the planned ratings:
- read this Wall Street Journal article (sub. req.)

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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

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Panel issues care guidelines for heart implant patients

Thu, 15 May 2008 06:59:55 -0400

In the past, much of the discussion over implantable heart devices like pacemakers and defibrillators was over which patients were suitable candidates--and how to get health plans to pay for them. Today, however, now that two million people world-wide have such devices in their chests, the question is how to care for such patients properly over the long term.

To address such issues, an international panel of heart specialists have issued guidelines for caring for such patients. The guidelines, which were announced at a meeting of the Heart Rhythm Society, address such issues as when to shut the device off in dying patients and stress the need for closer follow-up care.

The guidelines also encourage the use of wireless technology that allows physicians to monitor patients remotely, while the patient is still at home. A related five-year study presented at the meeting found that over five years, raising the volume of patients being remotely monitored from 94 to more than 5,000 didn't pose a big burden on clinic staff.

To learn more about the guidelines, and the Clinic's remote monitoring research:
- read this Associated Press article

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Medicare releases volume, customer satisfaction data

Mon, 31 Mar 2008 07:59:58 -0400

For the first time, Medicare has released volume and payment information for a list of selected conditions, along with the results from its new consumer satisfaction survey, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Medicare already posts hospital quality data for heart attack, heart failure, pneumonia and surgical care to its Hospital Compare website. The agency now will add information showing how often Medicare patients were admitted to hospitals for a set of conditions, as well as what Medicare paid for treatments to the site and HCAHPS data. The HCAHPS data includes feedback from more than 2,500 hospitals participating in the program's launch.

To learn more about Medicare's plans:
- read this Modern Healthcare article (reg. req.)

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PA puts hospital quality data online

Wed, 19 Mar 2008 07:59:55 -0400

A Pennsylvania group has launched a new website offering quality reports that compare hospital performance and outcomes for the state. On the site, which includes data from all 162 primary acute care hospitals in the state, users can look up which hospitals have the best record in relation to certain conditions like heart attacks, heart failure or rates of hospital-acquired infections. Users can compare hospitals to each other, as well as to state and national averages for quality of care. They also can search for individual hospitals by ZIP code, county or name. The hospital data, which is being published by the Pennsylvania Health Care Quality Alliance, comes from CMS, the Pennsylvania Health Care Cost Containment Council and the Joint Commission. This makes Pennsylvania one of less than a dozen states to offer such comparative information.

To learn more about this effort:
- visit its site
- read this Associated Press article

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Study: Hispanics get lower-quality medical care

Wed, 12 Mar 2008 07:59:54 -0400

It's more discouraging news from the health disparity front: A new study suggests that elderly Hispanics tend to get inferior care. The study, which looked at Medicare data from 2004, found that hospitals with high percentages of Hispanic patients seem to have slightly lower quality ratings for heart attack, congestive heart failure and pneumonia care. This ties in with data from the past 20 years demonstrating that minorities get lower quality care in the U.S., even when the data is adjusted for age, patient acuity, income level and insurance status, said Dr. Ashish Jha of the Harvard School of Public Health, who led the study.

The study also noted that the disparity extends to where Hispanics are treated, as well what care they get. According to the research, more than half of African Americans and Hispanics get treated at only 5 percent of the nation's hospitals.

To learn more about this research:
- read this piece from The Miami Herald

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