HospitalistWeekly 5-14-08
Highlights
- Stay up-to-date with live coverage from Internal Medicine 2008
- Safety net hospitals try rerouting nonurgent care
Stroke
- Hospitalization rates for ischemic stroke decrease over eight years, AHRQ reports
- Stroke outcomes after rehab differ by racial and ethnic groups, study finds
Regulatory actions
- Alcohol-free mouthwash recalled, may contain B. cepacia
Tools on the Web
- Survey assesses confusion over drug-name suffixes
- Site offers prescription assistance to patients, providers
From ACP Hospitalist
- Suggest a colleague as a Hospitalist of the Year
Cartoon caption contest
- Put words in our mouth: Vote for your favorite entry
Highlights
.Stay up-to-date with live coverage from Internal Medicine 2008
The ACP news staff is providing live online coverage of Internal Medicine 2008. Those attending the meeting can read about upcoming sessions and get recaps of previous sessions they may have missed through our onsite daily newspaper, Internal Medicine 2008 News. For those not attending, our Web site will be updated throughout the day with a synopsis of news and events from the meeting. Also, visit our blog, where you can read our staff postings and add your own comments.
.Safety net hospitals try rerouting nonurgent care
Emergency departments at safety net hospitals are looking for ways to redirect patients who don't need urgent treatment, according to a new report from the Center for Studying Health System Change (HSC).
The HSC conducts site visits every two years in 12 nationally representative metropolitan areas. In 2007, it found that busy EDs at safety net hospitals are attempting to solve overcrowding for nonurgent care by helping patients establish "medical homes," increasing referrals to clinics, assisting patients in scheduling appointments, and collaborating with health centers, among other methods.
The report concluded that ED overcrowding due to nonurgent care could be mediated by a combination of these solutions. In addition, the authors recommended coordinating hours of operation among providers and services; providing transportation in low-income areas; improving communication and coordination among community providers and ED staff; and increasing patients' knowledge about alternative sources of low-cost care.
The HSC's report is online.
Stroke
.Hospitalization rates for ischemic stroke decrease over eight years, AHRQ reports
Hospitalizations for ischemic stroke decreased by one-third between 1997 and 2005, while rates for hemorrhagic stroke remained steady, the Agency for Healthcare Research and Quality (AHRQ) recently reported.
Approximately 36 per 10,000 Americans age 45 years and older were hospitalized for ischemic stroke in 2005, compared with approximately 54 per 10,000 persons in 1997. Hospitalizations for hemorrhagic stroke in this age group, however, did not change substantially during the same time period (range, nine to 11 per 10,000 persons). The findings were part of a statistical brief released by AHRQ's Healthcare Cost and Utilization Project, which analyzed data from the Nationwide Inpatient Sample.
Other 2005 findings from the report included the following:
- Hospitalizations for stroke numbered 892,300 and accounted for $8.5 billion in hospital costs.
- 25.1% of hemorrhagic stroke patients died in the hospital versus 5.9% of patients with ischemic stroke.
- The likelihood of transfer to rehab or nursing homes differed by condition (ischemic stroke, 44%; hemorrhagic stroke, 36.9%; transient cerebral ischemia, 13.2%; and occlusion/stenosis of precerebral arteries, 4.8%).
- One in 10 people admitted for hemorrhagic stroke was younger than 45 years of age.
The AHRQ report is online![[PDF]](/graphics/new/pdf.gif){kind=small}
.
Stroke outcomes after rehab differ by racial and ethnic groups, study finds
Non-Hispanic white patients have better outcomes after postacute care for stroke than Hispanic and black patients, according to a recent study.
Previous studies have found racial and ethnic differences in stroke incidence, type and severity. Researchers used data from the Uniform Data System for Medical Rehabilitation, a U.S. registry of rehabilitation inpatients, to determine whether outcomes after inpatient stroke rehab also differed by race and ethnicity. Data from 161,692 patients (mean age, approximately 71 years) were analyzed. Seventy-six percent of patients were of non-Hispanic white ethnicity, and 53% were women. The study appeared in the May issue of Stroke.
The authors found that although length of stay was similar for all ethnic groups, non-Hispanic white patients had better functional status at hospital discharge than patients of other racial or ethnic backgrounds. Differences in functional status by race or ethnicity increased with age. Non-Hispanic white patients were less likely to be discharged home than black patients (odds ratio, 0.64), Hispanic patients (odds ratio, 0.58) or those from other minority groups (odds ratio, 0.67). Although discharge to home is generally considered a positive outcome, the authors speculated that their findings could reflect differences in family support, attitudes toward nursing homes or financial resources.
The authors acknowledged that their study had limitations, including possible selection bias and lack of detailed treatment and rehab information. However, the authors concluded that outcomes after acute care vary by race and ethnicity in stroke patients. Future studies, they wrote, should attempt to replicate their findings and begin to search for ways to resolve such disparities.
Stroke is online.
Regulatory actions
.Alcohol-free mouthwash recalled, may contain B. cepacia
Cardinal Health’s alcohol-free mouthwash is being voluntarily recalled by its manufacturer because it has tested positive for Burkholderia cepacia (B. cepacia), which can cause infections in hospitalized patients, the FDA said.
At least one hospital illness has been associated with the mouthwash, which is distributed to hospitals, medical centers, and long-term care facilities nationwide, and can be found in certain personal hygiene hospital admission kits. Product lot number 26228 is affected by the recall.
While B. cepacia poses little risk to healthy people, patients with weakened immune systems or chronic lung diseases, particularly cystic fibrosis, may be more susceptible to infections with B. cepacia. The bacteria are often resistant to common antibiotics, the FDA said.
The FDA recall notice is online.
Tools on the Web
.Survey assesses confusion over drug-name suffixes
The National Coordinating Council for Medication Error Reporting and Prevention is asking for ACP members’ input about using suffixes in drug names. The anonymous, 10-minute survey will assess their current use, problems that may arise from their use and how those situations are handled.
The current practice of naming drug products within the same product line, such as those with different strengths or formulations, is to add a suffix to the existing name rather than an entirely different one. Suffixes may be a letter, number, word, or combination of letters and/or numbers attached to the end of a proprietary drug name. They can range from one to four character strings of numbers or letters that don't spell anything, or can be a word or a word part that describes the package, a package characteristic or a product characteristic.
.Site offers prescription assistance to patients, providers
A Web site offers prescription assistance programs for more than 1,000 drugs to patients and their caregivers, doctors or hospitals. Published by Johnson & Johnson Health Care Systems, the site combines information about the company’s own patient assistance program, as well as the Partnership for Prescription Assistance, Together Rx Access, Medicare Part D, and state and local programs. A simple two-step tool will help determine eligibility for any of the assistance programs described on the site.
From ACP Hospitalist
.Suggest a colleague as a Hospitalist of the Year
ACP Hospitalist is seeking candidates for our first annual Hospitalists of the Year issue. We're looking for the hospitalists who made the most notable contributions to the field in 2008, whether through cost savings, improved work flow, patient safety, leadership, mentorship or quality improvement.
Do you know a colleague who might qualify? Fill out our form and tell us who and why. All recommendations must be received by July 14, 2008, when our editorial advisory board will pick the winners. Hospitalists of the Year will be profiled in our November 2008 issue.
Cartoon caption contest
.Put words in our mouth: Vote for your favorite entry
Our cartoon caption contest continues. ACP staff has selected three finalists for the latest contest and is now asking readers to vote for their favorite caption to determine the winner.
Go online to view the cartoon and then pick the winner, who receives a $50 gift certificate good for any ACP product, program or service.
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