In the News

Quality of health care affected by race and geography.

Quality of health care affected by race and geography, report finds

Getting mammograms and other basic recommended health care varies significantly by race and geographic region, according to a report on Medicare beneficiaries released in early June by the Robert Wood Johnson Foundation.

Researchers at the Dartmouth Atlas Project at the Dartmouth Institute for Health Policy and Clinical Practice analyzed Medicare claims on five quality measures and found that overall, blacks were less likely than whites to get recommended care and that quality varied across regions. One in three women did not get mammograms in 2004-05, the study reported. Blacks were less likely than whites to undergo the screening (57% vs. 64%, respectively), while Maine fared best (74%) and Mississippi worst (57%) in regional comparisons.

The most striking racial disparity was for leg amputations due to complications from peripheral vascular disease and diabetes, the report said. African Americans were five times as likely to lose a leg as were whites (4.17 per 1,000 beneficiaries vs. 0.88 per 1,000, respectively), with the highest rate of amputations in Louisiana (1.66 per 1,000 patients).

In conjunction with the report's release, the Robert Wood Johnson Foundation announced a $300 million initiative called Aligning Forces for Quality aimed at improving care in 14 communities across the U.S.

Progress made on surge capacity, but gains may not last, study finds

Recent progress toward improved surge capacity in the U.S. may not be permanent, a recent study reported.

The Center for Studying Health System Change looked at development of surge capacity programs in six U.S. communities—Boston; Greenville, S.C.; Miami; Phoenix; Orange County, Calif.; and Seattle—and interviewed national experts and officials in New York City, Washington, D.C., and New Orleans. The study aimed to determine how these communities had worked to improve their surge capacity as well as the obstacles they faced in maintaining and furthering these gains.

The authors found that communities have become much more aware of the need for improved surge capacity and have developed multiple plans to deal with possible disasters. However, communities also reported that federal funding for surge capacity efforts has been declining, making it more difficult to keep up and expand existing programs. Hospitals face particular financial pressure because surge capacity programs are not subsidized by private or public payers and because surge capacity development is not profitable, the study authors wrote. Staffing issues are also a matter of concern. Some communities are attempting to take the pressure off hospitals by encouraging patients to seek out other providers for nonemergent care in a disaster and by ensuring that long-term care facilities and mental health facilities are included in disaster planning.

The study authors concluded that broad support, participation and collaboration are necessary for successful surge capacity planning, that adequate funding for surge capacity programs must be maintained, and that workforce and staffing issues must be addressed.

New inpatient psychiatric measures announced

The Joint Commission recently announced a new set of inpatient psychiatric measures that satisfy current ORYX performance measurement requirements. The new measures will take effect on Oct. 1, 2008, and can be used by accredited hospitals providing acute inpatient psychiatric services.

The final measure set includes the following:

  • Admission screening for violence risk, substance use, psychological trauma history and patient strengths completed;
  • Hours of physical restraint use;
  • Hours of seclusion use;
  • Patients discharged on multiple antipsychotic medications;
  • Patients discharged on multiple antipsychotic medications with appropriate justification;
  • Postdischarge continuing care plan created; and
  • Postdischarge continuing care plan transmitted to next level of care provider upon discharge.

New guidelines on antithrombotic therapy released

The American College of Chest Physicians has issued new guidelines on antithrombotic therapy emphasizing prophylaxis and management in specific populations, including perioperative patients.

The guidelines, published as a supplement to the June issue of Chest, include the following strong recommendations:

  • Every general hospital should develop a formal, active strategy to address the prevention of venous thromboembolism.
  • Hospitals should not rely on passive methods to increase thromboprophylaxis adherence but should instead encourage use of computer decision support systems, preprinted orders and periodic audit and feedback.
  • Thromboprophylaxis other than early and frequent ambulation is not recommended in low-risk general surgery patients.
  • Patients undergoing major general surgery should receive thromboprophylaxis until hospital discharge.
  • Patients who are asymptomatic after major orthopedic surgery should not be routinely screened with duplex ultrasonography before discharge.

Additional recommendations address trauma, critical care, venous thromboembolic disease and prophylaxis in pregnant women and children, among other topics.