Physicians Eager but Unprepared to Meet Meaningful Use Requirements

April 27, 2012 By Leave a Comment

Most physicians were eligible for federal incentives in 2011, but few had EHR systems that met Meaningful-use criteria.

Meaningful use (MU), in a health information technology (HIT) context, defines the use of electronic health records (EHR) and related technology within a healthcare organization. Achieving meaningful use also helps determine whether an organization will receive payments from the federal government under either the Medicare EHR Incentive Program or the Medicaid EHR Incentive Program.

Although roughly half of physicians in a recent survey said they planned to apply to the Meaningful Use incentive program in 2011, few would have qualified for payments because their electronic health record systems would not have met enough of the Stage 1 core requirements, according to a study published this week in Health Affairs.

Of nearly 4,000 physicians responding to the survey, conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics, 51 percent said they intended to apply for the incentive payments. Only 11 percent, however, had an EHR system installed that would have met 10 out of 15 requirements for the Stage 1′s core objectives.

Such statistics should serve as a guide to current and future efforts by regional extension centers (RECs) designated to aid physicians in their push toward meeting Meaningful Use, according to the study’s authors. Physicians working with RECs toward Meaningful Use attestation have encountered multiple obstacles, according to analysis from earlier in the year by the ONC’s Health IT Policy Committee.

“The 2011 survey results portray widespread gaps in readiness,” the authors wrote. “Even in Wisconsin, the state with the highest percentage ready [to hit 10 of 15 core requirements], only 32 percent of all physicians reported this degree of readiness.”

Despite the results of the Health Affairs study, the number of eligible hospitals and professionals registered to participate in the EHR Incentive Programs continues to climb, according to recent statistics released by the Centers for Medicare & Medicaid Services. Additionally, according to CMS’s statistics, $4.5 billion in incentive payments have been made to eligible providers as of this past March.

View Health Affairs Abstract for more information – click here.
Original article content courtesy of FierceHealthIT.
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Mandatory Overtime Caps for Nurses Having Effect

January 31, 2012 By Leave a Comment

State-mandated caps on nurses’ mandatory overtime hours have been effective in reducing overtime hours for new RNs, according to a study.

The study is part of the RN Work Project, a 10-year longitudinal study of newly licensed RNs (NLRNs) that began in 2006 and is funded by the Robert Wood Johnson Foundation. The overtime study drew on data from nurses in 34 states, covering 51 metropolitan areas and nine rural areas.

Past research has demonstrated that fatigue caused by long hours without sufficient rest between shifts can lead to mistakes that imperil both patients and nurses.

“The purpose of capping mandatory overtime is to make hospitals safer for patients and nurses,” study investigator Carol Brewer, RN, PhD, FAAN, professor at the University of Buffalo School of Nursing, said in a news release. “Nurses routinely work long shifts, often as long as 12 hours straight. These laws were intended to prevent hospitals from piling mandatory overtime on top of such shifts, a practice that research shows can increase the likelihood of mistakes. The laws seem to be accomplishing their objective.”

According to the study, in 2010, 16 states had rules restricting mandatory overtime hours for nurses: Arkansas, California, Connecticut, Illinois, Maryland, Minnesota, Missouri, New Jersey, New Hampshire, New York, Oregon, Pennsylvania, Rhode Island, Texas, Washington and West Virginia. At issue in the study was the extent to which those laws or regulations had actually affected the workplace. Researchers examined NLRNs’ self-reported mandatory and voluntary overtime hours, as well as their total work hours.

They found that in the states with rules governing mandatory overtime, NLRNs were 59% less likely to work mandatory overtime than their colleagues in unregulated states. (Not all states with overtime rules prohibit mandatory overtime, with some simply limiting total work hours.) Overall, 11.6% of nurses said they worked mandatory overtime in a typical work week, averaging 6.1 hours.

In the states regulating overtime, NLRNs worked an average of 50 fewer minutes per week than their colleagues in states without overtime regulations.

Researchers anticipated that caps on mandatory overtime might lead to increased voluntary overtime, thus defeating the purpose of the restrictions to some degree. But the data demonstrated no relationship between mandatory and voluntary overtime hours. Nevertheless, more than 50% of NLRNs reported working voluntary overtime in a typical workweek.

“While safety is the principal objective of caps on mandatory overtime, the laws probably also have a positive effect on nurse retention,” said study investigator Christine Koyner, RN, PhD, FAAN, professor at the New York University College of Nursing. “Nurses have lives and families outside the workplace just like everybody else, and they probably prefer to have a schedule they can rely on. One way to make their jobs and lives more manageable is to avoid mandatory overtime, which should lead to nurses staying in their jobs, and indeed in the profession longer.”

“The states developed caps on mandatory overtime with safety issues in mind, reasoning that fewer mandatory overtime hours would translate into fewer hours,” said study investigator Sung-Heui Bae, RN, PhD, MPH, assistant professor at the University of Buffalo School of Nursing. “What we learned in this study is that it’s working. The tool is effective. Other states with similar objectives can follow suit and expect similar results.”

RN Work Project

According to RWJF, the RN Work Project (www.rnworkproject.org) is the only multi-state, longitudinal study of new nurses’ turnover rates, intentions and attitudes — including intent, satisfaction, organizational commitment and preferences about work. To date, researchers have learned that more RNs work in hospitals than any other settings early in their careers, with 88.3% working in hospitals six to 18 months after licensure and 78.8% working in hospitals 31 to 54 months after receiving their license.

The study has also revealed that 18.1% of new nurses leave their first employer within a year of starting a job, and 26.2% leave within two years. Nine in 10 of those who leave remain in nursing.

Subsequent studies will determine why nurses stay in or leave their jobs, what influences their first job choice, how the job settings they work in vary over time and whether they move in and out of nursing.

The study appears in an online edition of Nursing Outlook and is available as a PDF at http://www.rnworkproject.org.

Original Article by Nurses.com News .

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100,000 Sought for Next Phase of Nurses’ Health Study

December 2, 2011 By Leave a Comment

The landmark Nurses’ Health Study is recruiting a new cohort of 100,000 female nurses and nursing students ages 20 to 46 from across the U.S. and Canada.

Described as the world’s largest and longest-running set of research on women’s health, the Nurses’ Health Study has included more than 230,000 participants since the 1970s. By completing confidential lifestyle surveys for more than three decades, the participating nurses have enhanced medical knowledge about nutrition, exercise, cancer and heart disease.

For example, bolstered by evidence from the study, according to a news release, many restaurants ban artificial trans fats. In the study, these fats were shown to contribute to heart disease.

The Nurses’ Health Study III will explore important issues in women’s health — including those related to the environment, work life, fertility and the effects of lifestyle — on a younger and more diverse group of women.

NHS3 is conducted entirely online, with participants completing brief confidential surveys every six months.

Approximately 20,000 nurses and nursing students have enrolled to date through sponsoring nursing associations, direct mail, social networks, the media and word-of-mouth through current participants. Recruitment will continue until the goal of 100,000 participants has been reached.

Eligible nurses can learn more on the study’s website: www.nhs3.org

Supported by

American Nurses Association | National Federation of Licensed Practical Nurses | National Black Nurses Association | Institute for Nursing | Healthcare Leadership | National League for Nursing | National Student Nurses Association

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Push to Curb Labor Costs Hurts Nursing Home Quality of Care Study Shows

November 30, 2011 By Leave a Comment

Low Staffing and Poor Quality of Care at Nation’s For-Profit Nursing Homes – The nation’s largest for-profit nursing homes deliver significantly lower quality of care because they typically have fewer staff nurses than non-profit and government-owned nursing homes.

That’s the finding of a new UCSF-led analysis of quality of care at nursing homes around the country. It is the first-ever study focusing solely on staffing and quality at the 10 largest for-profit chains.

Charlene Harrington, RN, PhD, FAAN

The article is published online in advance of print publication in Health Services Research.

“Poor quality of care is endemic in many nursing homes, but we found that the most serious problems occur in the largest for-profit chains,” said first author Charlene Harrington, RN, PhD, professor emeritus of sociology and nursing at the UCSF School of Nursing. Harrington also is director of the UCSF National Center for Personal Assistance Services.

“The top 10 chains have a strategy of keeping labor costs low to increase profits,” Harrington said. “They are not making quality a priority.”

Low nurse staffing levels are considered the strongest predictor of poor nursing home quality.

The 10 largest for-profit chains operate about 2,000 nursing homes in the United States, controlling approximately 13 percent of the country’s nursing home beds.

In recent decades, nursing home chains have undergone a considerable expansion.A number of chains were publicly-traded companies until the early 2000s, when five of the country’s largest chains went bankrupt. Following restructuring and ownership changes, as well as increases in Medicare payments, the largest chains became more financially stable. More recently, some of the largest publicly held chains were purchased by private equity investment firms, which invest funds received from investors, with whom they share profits and losses.

The researchers compared staffing levels and facility deficiencies at the for-profit chains to those at homes run by five other ownership groups to measure quality of care. The 10 largest chains were selected because they are influential in the nursing home industry and are the most successful in terms of growth and market share.

The study found that for-profit homes strive to keep their costs down by reducing staffing, particularly RN staffing.

Recent Medicare cuts in payment rates for nursing home residents – by 11 percent in October, 2011 – may further jeopardize the health and safety of residents if the chains respond by reducing staffing and wages, Harrington said.

The 10 largest for-profit chains in 2008 were HCR Manor Care, Golden Living, Life Care Centers of America, Kindred Healthcare, Genesis HealthCare Corporation, Sun Health Care Group, Inc., SavaSeniorCare LLC, Extendicare Health Services, Inc., National Health Care Corporation, and Skilled HealthCare, LLC.

From 2003 to 2008, these chains had fewer nurse “staffing hours” than non-profit and government nursing homes when controlling for other factors. Together, these companies had the sickest residents, but their total nursing hours were 30 percent lower than non-profit and government nursing homes. Moreover, the top chains were well below the national average for RN and total nurse staffing, and below the minimum nurse staffing recommended by experts.

The 10 largest for-profit chains were cited for 36 percent more deficiencies and 41  percent more serious deficiencies than the best facilities. Deficiencies include failure to prevent pressure sores, resident weight loss, falls, infections, resident mistreatment, poor sanitary conditions, and other problems that could seriously harm residents.

The study also found that the four largest for-profit nursing home chains purchased by private equity companies between 2003 and 2008 had more deficiencies after being acquired. The study is the first to make the connection between worse care following acquisition by private equity companies.

The authors said that more study is needed on the subject. They also said that greater accountability and quality oversight mechanisms would help improve nursing home care, along with effective funding incentives and sanctions for low staffing and poor quality.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.

Article Source: UCSF Elizabeth Fernandez

Study: Abstract
Study Supporting Information:
Appendix A.  Description of the Top 10 For-Profit Nursing Home Companies

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Measuring Quality Does Improve Doctors’ Care a Study Finds

October 24, 2011 By Leave a Comment

Wisconsin collaborative says disclosing rankings pushes doctors to try harder

The Wisconsin Collaborative for Healthcare Quality was founded on a simple premise: To improve the quality of health care, you must be able to measure it.

It is one of the underlying principles in the efforts to provide better care to patients.

Yet the premise that tracking the quality of care truly prods physicians to change the way they practice medicine has been more accepted than studied.

The Wisconsin Collaborative for Healthcare Quality, started by a group of large physician practices and health care systems in 2003, now can be cited as an example that it does.

A study led by Geoffrey Lamb, a professor at the Medical College of Wisconsin, compared the care given to diabetic patients by physician practices that belong to the collaborative with the care given by physicians in Iowa and South Dakota as well as national performance measures.

The study found that the collaborative’s members improved overall in every measure, such as monitoring a diabetes patient’s kidney function, which was tracked for more than two years.

“These were changes that really impacted a lot of people,” said Lamb, associate director of the Joint Quality Office of the Medical College of Wisconsin and Froedtert Hospital.

“The thing that really impressed me is the people who performed the lowest when they started had the greatest improvement,” he said. “They cared where they were in ranking.”

That gives additional credence to the long-standing contention that publicly disclosing how doctors perform on various measures of health care quality can result in better care.

“Transparency matters,” said Christopher Queram, president and chief executive of the collaborative.
[Read more...]

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Are Bedside Manners Important? A Study on Patient Communication Skills Thinks So

September 1, 2011 By Leave a Comment

Training helps surgical residents improve some communication skills. But progress was not seen in empathy, pacing of dialogue and eliminating jargon when talking to patients, a study shows.

With some training, surgical residents can improve the quality of information they communicate to patients about a specific condition, such as prostate cancer. But the training doesn’t improve more general communication skills, such as empathy, says a study in the August Archives of Surgery.

The study focused on 44 University of Connecticut School of Medicine general surgery residents who participated in a three-part interactive program. The program featured learning principles of patient communication, role-playing, and hearing a surgeon’s experience as a physician, patient and patient’s spouse.

Before the training, residents scored a median 65% on a checklist of items they needed to cover with patients, including explaining what type of cancer the patient has, asking about the patient’s emotions and discussing treatment. After training, the median score for what the study called case-specific communication skills jumped to 84% (abstract link).

But improvement was not seen in general communication skills such as pacing of dialogue, questioning, effective summarizing and eliminating jargon when talking to a patient. Empathy and other nonverbal communication didn’t improve, either.

Study lead author Rajiv Y. Chandawarkar, MD, said it was encouraging to see that a short burst of training could improve case-specific communication.

“Case-specific information is very critical to the actual care of patients. … You can address questions before a patient has even had a chance to form them,” said Dr. Chandawarkar, associate professor and chief of the division of plastic and reconstructive surgery at the University of Connecticut School of Medicine in Farmington.

To enhance general communication skills, such as decreasing jargon and improving effective summarizing, study authors said it probably would take “sustained coaching with repeated practice rather than a one-time session” to see improvement. They noted that empathy and nonverbal communication have an innate component, making it more difficult to improve such skills.

The Accreditation Council for Graduate Medical Education lists communication as a core competency for physicians in training. Dr. Chandawarkar said residency programs need to focus more on helping physicians in training improve patient communication.

“Training now is focused on creating technically good doctors,” he said. “But without communication skills, even the best doctors won’t achieve their potential.”

Study authors said their training methods could be modified for other residency programs and used in teaching hospitals and community health centers. Though the study focused on how to communicate with a cancer patient, Dr. Chandawarkar said the training could help residents communicate about scenarios such as end-of-life care, trauma, pediatric care and care for the elderly.

Article source AMA Association AMedNews

 

 

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Nurse Case Managers Improve Cardiac Risk Control in Diabetes for Veterans

August 8, 2011 By Leave a Comment

Nurse case managers can help more patients control hypertension, hyperglycemia, and hyperlipidemia

Nurse case managers can improve the percentage of patients with diabetes who achieve control of hypertension, hyperglycemia, and hyperlipidemia, according to a study published in the August issue of Diabetes Care.

Areef Ishani, M.D., from the Minneapolis Veterans Affairs Health Care System, and colleagues assessed whether nurse case management using therapeutic algorithm can effectively improve rates of control of hypertension, hyperglycemia, and hyperlipidemia compared with usual care among 556 veterans with diabetes. At baseline, patients had blood pressure (BP) >140/90 mmHg, hemoglobin A1c (HbA1c) >9.0 percent, or LDL >100 mg/dL. The percentage of patients achieving simultaneous control of all three parameters (BP <130/80 mm Hg, HbA1c <8.0 percent, and LDL <100 mg/dL) at one year was the primary outcome, while improvement within each individual component of the composite primary outcome was the secondary outcome.

The investigators found that having all three parameters under control was achieved in a significantly larger number of patients assigned to nurse case management compared with the usual-care group (21. 9 versus 10.1 percent). As compared to patients in the usual-care group, the treatment goals of HbA1c and BP were achieved by a larger number of patients assigned to the intervention group (73.7 versus 65.8 percent and 45.0 versus 25.4 percent, respectively), but there was no significant difference in the number of patients who achieved the treatment goals for LDL (57.6 versus 55.4 percent).

“In patients with diabetes, nurse case managers using a treatment algorithm can effectively improve the number of individuals with control of multiple cardiovascular risk factors at one year,” the author writes.

 

Article source: HealthDay News

Study Abstract
Full Text (subscription or payment may be required) at Diabetes Journals

 

 

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Study Examines High-Speed Internet Use, Rx Abuse

May 13, 2011 By Leave a Comment

Is there a link between the expansion of high-speed Internet connectivity and rising rates of prescription-drug abuse?

Possibly, according to a study, “Growing Internet Use May Help Explain The Rise In Prescription-Drug Abuse in the United States” published online in the policy journal Health Affairs. (link to study below)

“Our findings provide a first glimpse that growing Internet use may partially explain why U.S. prescription-drug abuse rates have risen dramatically while other substance-abuse rates have not,” the authors noted in a news release. “Based on our findings, recent efforts by the (U.S.) Food and Drug Administration to shut down illegitimate pharmacies not only seem warranted but may also lead to substantial reductions in prescription-drug abuse.”

The report is based on comparisons of U.S. Federal Communications Commission data on several states’ rates of Internet penetration from 2000 to 2007 and U.S. Substance Abuse and Mental Health Services Administration data on admissions to substance-abuse programs.

During the study period, researchers determined that admissions for alcohol, cocaine and heroin abuse had minimal or negative growth, whereas in those states with higher Internet growth “experienced comparable increases in admission to substance-abuse treatment facilities,” according to the release.

“Our work raises the possibility that the observed growth in U.S. prescription-drug abuse may partially stem from wider Internet availability through online pharmacies that sell prescription drugs illegally,” according to the authors.

Summary From:  Modern Healthcare

Study Abstract:

The rising availability through the Internet of commonly abused prescription drugs has raised public health concerns. We examined whether the growth of US prescription drug abuse may be explained by the parallel growth in high-speed Internet use. We find that for every 10 percent increase in high-speed Internet use at the state level, associated treatment facility admissions for prescription drug abuse rose by 1 percent. Admissions for abuse of alcohol, cocaine, and heroin, which are not readily purchased online, had minimal or negative growth during the same period. The results suggest that better surveillance of online prescription drug sales is warranted, and aggressive efforts to curb illegitimate online pharmacies may be necessary.

Link to study: Growing Internet Use May Help Explain The Rise In Prescription Drug Abuse In The United States

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Super Bowl May Trigger Heart Attacks – Are You at Risk?

February 1, 2011 By Leave a Comment

This Sunday’s Super Bowl could prove to be a real heartbreaker for some fans of the losing team. A new study suggests that the emotional stress fans feel after a loss may trigger fatal heart attacks, especially in people who already have heart disease.

Stress generates the so-called fight-or-flight response, which causes sharp upticks in heart rate and blood pressure that can strain the heart. For people with heart disease—or for those who are at risk due to factors such as obesity, smoking, and diabetes—such strain can prove harmful, if not fatal.

In the study, which was published today in the journal Clinical Cardiology, researchers analyzed death records in Los Angeles County for the two weeks following the 1980 and 1984 Super Bowls, both of which featured teams from Los Angeles. (The game days were included.) Then, as a control, the researchers looked at the same data from the corresponding days in the intervening years.

In 1980, when the Pittsburgh Steelers staged a fourth-quarter comeback to beat the underdog L.A. Rams, heart-related deaths shot up 15% among men and 27% among women in the subsequent two weeks, compared to the same period in 1981 through 1983. There was also a significant increase in deaths among people ages 65 and older, the study found.

The 1984 Super Bowl was a different story. The L.A. Raiders handily beat the Washington Redskins, and unlike four years earlier, the cardiac death rate didn’t increase after the game. In fact, the death rate for women and older people dropped slightly.

“Fans develop an emotional connection to their team…and when their team loses, that’s an emotional stress,” says the lead author of the study, Robert A. Kloner, MD, a professor of cardiology at the University of Southern California’s Keck School of Medicine, in Los Angeles. “There’s a brain-heart connection, and it is important for people to be aware of that.”

The apparent link between the Super Bowl loss and heart-related deaths is plausible but largely speculative. Dr. Kloner and his colleagues looked only at death-certificate data, not individuals, and they can’t be sure that the people who succumbed to heart attacks following the 1980 game were Rams fans, or even watched the game.

David Frid, MD, a cardiologist at the Cleveland Clinic who was not involved in the study, agrees that “emotional triggers” can set off heart attacks and other cardiac events. But he’s not convinced that grief caused by the hometown loss was responsible for the spike in deaths.

“Was it due to the fact that the Rams lost?” Dr. Frid asks. “Or was it the emotional roller coaster of the game itself? Does it have to do with the excitement of the event?”

The 1980 Super Bowl was indeed an intense contest, as the study notes. The Rams and Steelers repeatedly traded the lead, and fans of both teams would have experienced extreme and fluctuating emotions—joy, frustration, anger, elation—throughout the game. (The fact that the game was played in the Rose Bowl, in Pasadena, may have only intensified the emotions for Rams fans.)

For a number of reasons, the 1984 game would have been much less stressful for people in Los Angeles. The outcome was never in doubt, the Raiders were relatively new to the city, and the game was played far from home, in Florida.

Stress may not be the only factor at work, however. For instance, consuming copious amounts of beer and fatty foods like buffalo wings—practically a requirement at many Super Bowl parties—can also trigger a potentially deadly heart attack. “One high-fat meal can cause your blood to be more likely to clot,” Dr. Frid says.

The researchers were surprised by the increase in heart-related deaths among women after the Rams’ loss. A similar study conducted in Germany during the 2006 World Cup found that heart attacks spiked on days when the German team played, but mainly among men.

“It may be the same emotional response as it is for men. Women root for their teams, too,” Dr. Kloner says. “Another possibility is that perhaps a mate’s reaction adversely affects the female.”

Many people in the U.S. have heart disease and don’t even know it, Dr. Frid says. With Super Bowl Sunday approaching, he has a simple piece of advice for fans whose diet or lifestyle may be putting them at risk for a heart attack: “Address what needs to be changed so that you can make it to the end of the game.”

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Surgical Checklists Reduce Medical Errors — And Could Cut Malpractice Claims: Study

January 14, 2011 By Leave a Comment

Surgical checklists not only save lives by preventing medical errors, they could also make a big dent in medical malpractice claims, according to a study in the Netherlands.

Using data from the country’s largest medical liability insurer, a team led by Eefje de Vries of the Academic Medical Center in Amsterdam found that nearly a third of the malpractice claims arose from mistakes that likely would have been caught by a checklist.

For the study, published in the Annals of Surgery, the team identified the main reasons for errors in 294 successful insurance claims related to surgeries from 2004 to 2005. They then compared those to the items on a comprehensive surgical checklist called SURPASS, which is now used in several hospitals in the Netherlands.

The checklist includes things such as making sure the operating schedule is correct, checking that all equipment is available, and marking on which side of the patient the surgery is going to happen.

“While the checklist as a whole may seem a little intimidating, the separate parts for each stage of the surgical pathway take little time to complete,” de Vries wrote.

They found that 29 percent of the reasons for lawsuits could be linked to a step on the checklist, such as marking the patient or communication between hospital staff.

And in four of the 10 deaths in the claims database, at least one of the contributing factors was addressed in the checklist.

While there is no guarantee the checklist would have avoided those deaths if it had been used at the time, the researchers say it would likely have prevented “a considerable amount of damage, both physical and financial.”

The costs are significant.

Putting a price tag on the medical liability system is difficult, but one 2010 study estimated it costs the United States more than $55 billion annually, or 2.4 percent of the country’s healthcare spending.

In addition, experts say tens of thousands of Americans die each year due to medical errors.

Earlier studies have shown that when healthcare providers follow a checklist, they reduce those deaths dramatically and could save money by preventing complications that require further treatment.

“This kind of evidence indicates that surgeons who do not use one of these checklists are endangering patients,” said Atul Gawande at the Harvard School of Public Health, a surgeon who has written extensively on the topic.

Yet only about a fourth of U.S. hospitals use one of the three checklists that have been proven to work, he added.

“The message for hospitals is you want to adopt one of these checklists,” he said.

SOURCE From Lippincott Williams & Wilkins, Inc.: bit.ly/hmFN4M

Article via Reuters Life!

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