Larry Beresford

Click here to listen to Dr. Johns

Click here to listen to Dr. Johns

Click here to listen to Dr. Johns

Click here to listen to the state officials

Click here to listen to the state officials

Click here to listen to the state officials

In less than four months CMS' Hospital Readmissions Reduction Program will start penalizing hospitals with higher-than-projected readmissions rates. But as the Oct. 1 program launch looms for many hospitals, one readmission initiative is making significant progress to reduce unnecessary hospitalizations.

The Minnesota Reducing Avoidable Readmissions Effectively (RARE) campaign set a goal of preventing 4,000 avoidable readmissions among commercial health plan patients by the end of 2012, a 20% reduction from 2009 baseline data. The campaign was launched last September by three operating partners: the Minnesota Hospital Association (MHA); the Institute for Clinical Systems Improvement (ICSI), a nonprofit collaborative of 55 medical groups and hospitals; and Stratis Health, the state's QI organization. RARE's partners include more than 80 hospitals, which according to the MHA already have prevented 1,011 avoidable readmissions in 2011 and expect to surpass the target goal by the end of 2012.

"We had a specific process for each partner to follow, including a commitment by leadership to support and provide needed resources and development of a guidance team and a working team at each site," says Kathy Cummings, RN, MA, project manager at ICSI.

Each participating hospital was invited to join one of three quality collaboratives: one based on Project RED; one based on Dr. Eric Coleman's Care Transitions model; and one focused on safe transitions-of-care communication developed by the MHA.

"Everyone is rallying around the goals. They are all talking at the table, and starting to break down the silos between hospital, nursing home, clinic, and the chasms in between," says hospitalist Howard Epstein, MD, FHM, ICSI's chief health systems officer. "One of the key attributes of hospitalists is collaboration and systems improvement within their hospitals. Working with RARE is broadening their perspectives on the workings of the healthcare system as a whole."

In less than four months CMS' Hospital Readmissions Reduction Program will start penalizing hospitals with higher-than-projected readmissions rates. But as the Oct. 1 program launch looms for many hospitals, one readmission initiative is making significant progress to reduce unnecessary hospitalizations.

The Minnesota Reducing Avoidable Readmissions Effectively (RARE) campaign set a goal of preventing 4,000 avoidable readmissions among commercial health plan patients by the end of 2012, a 20% reduction from 2009 baseline data. The campaign was launched last September by three operating partners: the Minnesota Hospital Association (MHA); the Institute for Clinical Systems Improvement (ICSI), a nonprofit collaborative of 55 medical groups and hospitals; and Stratis Health, the state's QI organization. RARE's partners include more than 80 hospitals, which according to the MHA already have prevented 1,011 avoidable readmissions in 2011 and expect to surpass the target goal by the end of 2012.

"We had a specific process for each partner to follow, including a commitment by leadership to support and provide needed resources and development of a guidance team and a working team at each site," says Kathy Cummings, RN, MA, project manager at ICSI.

Each participating hospital was invited to join one of three quality collaboratives: one based on Project RED; one based on Dr. Eric Coleman's Care Transitions model; and one focused on safe transitions-of-care communication developed by the MHA.

"Everyone is rallying around the goals. They are all talking at the table, and starting to break down the silos between hospital, nursing home, clinic, and the chasms in between," says hospitalist Howard Epstein, MD, FHM, ICSI's chief health systems officer. "One of the key attributes of hospitalists is collaboration and systems improvement within their hospitals. Working with RARE is broadening their perspectives on the workings of the healthcare system as a whole."

In less than four months CMS' Hospital Readmissions Reduction Program will start penalizing hospitals with higher-than-projected readmissions rates. But as the Oct. 1 program launch looms for many hospitals, one readmission initiative is making significant progress to reduce unnecessary hospitalizations.

The Minnesota Reducing Avoidable Readmissions Effectively (RARE) campaign set a goal of preventing 4,000 avoidable readmissions among commercial health plan patients by the end of 2012, a 20% reduction from 2009 baseline data. The campaign was launched last September by three operating partners: the Minnesota Hospital Association (MHA); the Institute for Clinical Systems Improvement (ICSI), a nonprofit collaborative of 55 medical groups and hospitals; and Stratis Health, the state's QI organization. RARE's partners include more than 80 hospitals, which according to the MHA already have prevented 1,011 avoidable readmissions in 2011 and expect to surpass the target goal by the end of 2012.

"We had a specific process for each partner to follow, including a commitment by leadership to support and provide needed resources and development of a guidance team and a working team at each site," says Kathy Cummings, RN, MA, project manager at ICSI.

Each participating hospital was invited to join one of three quality collaboratives: one based on Project RED; one based on Dr. Eric Coleman's Care Transitions model; and one focused on safe transitions-of-care communication developed by the MHA.

"Everyone is rallying around the goals. They are all talking at the table, and starting to break down the silos between hospital, nursing home, clinic, and the chasms in between," says hospitalist Howard Epstein, MD, FHM, ICSI's chief health systems officer. "One of the key attributes of hospitalists is collaboration and systems improvement within their hospitals. Working with RARE is broadening their perspectives on the workings of the healthcare system as a whole."

Banner Good Samaritan Medical Center in Phoenix is combating hospital-acquired VTE with a quality initiative that uses risk-assessment tools and order sets embedded in the electronic health record (EHR) and real-time interventions with physicians.

Cases of hospital-acquired VTE are identified as they occur and assessed for whether they were preventable, says Lori Porter, DO, academic hospitalist and team leader for Banner Good Samaritan's VTE Committee. "If we think the VTE was preventable, we will call the provider and say, 'Can you tell me why you think this happened?'" she says. (Check out more information about Banner Good Samaritan’s VTE program at the Institute for Healthcare Improvement website.)

The program emphasizes risk re-assessment, appropriate use of extended prophylaxis, and involvement of Banner's house staff. All four hospitalist services at Banner Good Samaritan have been receptive to using the order sets.

Banner Good Samaritan's results include a drop in preventable hospital-acquired VTEs to 25% in 2011 from 45% in 2009, along with a 29% relative risk reduction in DVT and 18% in pulmonary embolism.

The hospital belongs to SHM's VTE Prevention Collaborative, and works with mentor Gregory Maynard, MD, MSc, SFHM, senior vice president of SHM's Center for Healthcare Improvement and Innovation. It uses what Dr. Porter calls "a simple, three-bucket system" for assessing and classifying risk level, derived from the 2008 antithrombotic therapy guidelines from the American College of Chest Physicians (ACCP). However, in February, ACCP issued a new edition of the guidelines, which Dr. Porter has not been eager to embrace.

"They've gone back to a conservative point-scoring system for risk assessment, which seems cumbersome in clinical practice. If a simpler approach has proven to be effective for us, then why commit to making a complicated change?" says Dr. Porter.

Dr. Maynard agrees that the new antithrombotic guidelines have sparked differences of opinion. Dr. Porter's teams, for example, "use the simpler three-bucket model with good results: better prophylaxis, decrease in VTE, and no discernible increase in bleeding," he says. "Improvement teams that want to mimic these results should look at this model, in addition to the models outlined in the ninth edition, and see which models their doctors and nurses would actually use reliably."

Banner Good Samaritan Medical Center in Phoenix is combating hospital-acquired VTE with a quality initiative that uses risk-assessment tools and order sets embedded in the electronic health record (EHR) and real-time interventions with physicians.

Cases of hospital-acquired VTE are identified as they occur and assessed for whether they were preventable, says Lori Porter, DO, academic hospitalist and team leader for Banner Good Samaritan's VTE Committee. "If we think the VTE was preventable, we will call the provider and say, 'Can you tell me why you think this happened?'" she says. (Check out more information about Banner Good Samaritan’s VTE program at the Institute for Healthcare Improvement website.)

The program emphasizes risk re-assessment, appropriate use of extended prophylaxis, and involvement of Banner's house staff. All four hospitalist services at Banner Good Samaritan have been receptive to using the order sets.

Banner Good Samaritan's results include a drop in preventable hospital-acquired VTEs to 25% in 2011 from 45% in 2009, along with a 29% relative risk reduction in DVT and 18% in pulmonary embolism.

The hospital belongs to SHM's VTE Prevention Collaborative, and works with mentor Gregory Maynard, MD, MSc, SFHM, senior vice president of SHM's Center for Healthcare Improvement and Innovation. It uses what Dr. Porter calls "a simple, three-bucket system" for assessing and classifying risk level, derived from the 2008 antithrombotic therapy guidelines from the American College of Chest Physicians (ACCP). However, in February, ACCP issued a new edition of the guidelines, which Dr. Porter has not been eager to embrace.

"They've gone back to a conservative point-scoring system for risk assessment, which seems cumbersome in clinical practice. If a simpler approach has proven to be effective for us, then why commit to making a complicated change?" says Dr. Porter.

Dr. Maynard agrees that the new antithrombotic guidelines have sparked differences of opinion. Dr. Porter's teams, for example, "use the simpler three-bucket model with good results: better prophylaxis, decrease in VTE, and no discernible increase in bleeding," he says. "Improvement teams that want to mimic these results should look at this model, in addition to the models outlined in the ninth edition, and see which models their doctors and nurses would actually use reliably."

Banner Good Samaritan Medical Center in Phoenix is combating hospital-acquired VTE with a quality initiative that uses risk-assessment tools and order sets embedded in the electronic health record (EHR) and real-time interventions with physicians.

Cases of hospital-acquired VTE are identified as they occur and assessed for whether they were preventable, says Lori Porter, DO, academic hospitalist and team leader for Banner Good Samaritan's VTE Committee. "If we think the VTE was preventable, we will call the provider and say, 'Can you tell me why you think this happened?'" she says. (Check out more information about Banner Good Samaritan’s VTE program at the Institute for Healthcare Improvement website.)

The program emphasizes risk re-assessment, appropriate use of extended prophylaxis, and involvement of Banner's house staff. All four hospitalist services at Banner Good Samaritan have been receptive to using the order sets.

Banner Good Samaritan's results include a drop in preventable hospital-acquired VTEs to 25% in 2011 from 45% in 2009, along with a 29% relative risk reduction in DVT and 18% in pulmonary embolism.

The hospital belongs to SHM's VTE Prevention Collaborative, and works with mentor Gregory Maynard, MD, MSc, SFHM, senior vice president of SHM's Center for Healthcare Improvement and Innovation. It uses what Dr. Porter calls "a simple, three-bucket system" for assessing and classifying risk level, derived from the 2008 antithrombotic therapy guidelines from the American College of Chest Physicians (ACCP). However, in February, ACCP issued a new edition of the guidelines, which Dr. Porter has not been eager to embrace.

"They've gone back to a conservative point-scoring system for risk assessment, which seems cumbersome in clinical practice. If a simpler approach has proven to be effective for us, then why commit to making a complicated change?" says Dr. Porter.

Dr. Maynard agrees that the new antithrombotic guidelines have sparked differences of opinion. Dr. Porter's teams, for example, "use the simpler three-bucket model with good results: better prophylaxis, decrease in VTE, and no discernible increase in bleeding," he says. "Improvement teams that want to mimic these results should look at this model, in addition to the models outlined in the ninth edition, and see which models their doctors and nurses would actually use reliably."

A recent study in the Journal of Hospital Medicine that found inpatients are similarly satisfied with the care provided by hospitalists and the care of primary-care physicians (PCPs) should be considered a positive for HM, says lead author Adrianne Seiler, MD, of the Division of Healthcare Quality at Baystate Medical Center in Springfield, Mass.¹

The results are drawn from scripted patient-satisfaction telephone interviews of 8,295 patients discharged from three Massachusetts hospitals from 2003 to 2009. Starting in 2007, questions were added from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) federal quality reporting system. Multivariate-adjusted satisfaction scores for physician care quality were only slightly higher for PCPs (4.24 on a five-point scale) than for hospitalists (4.20), with no statistical difference for individual hospitals or for different hospitalist groups.

“What has been passed down as dogma is the discontinuity in care introduced by the hospitalist model,” Dr. Seiler says. But actual data on the effects of the hospitalist model on patient satisfaction are scant. “Our finding that patients essentially were equally satisfied with either model of medical care—that’s huge.”

HCAHPS scores have not been validated to evaluate patient satisfaction with individual hospitalist providers specifically, Dr. Seiler says, but they are standardized nationwide. “Is this the best way to measure patient experience?” she asks. “It’s the best tool we have at this time.”

Another wrinkle in patient satisfaction was presented as an oral research abstract at HM12. Researchers from the Veterans Administration and the University of Michigan examined the association between hospitalist staffing levels and patient satisfaction.² Hospitals with the highest hospitalist staffing had modestly higher patient satisfaction scores than those with the lowest hospitalist staffing. Overall satisfaction was 65.6 for hospitals in the highest tertile of hospitalist staffing versus 62.7 those in the lowest tertile.

References

1. Seiler A, Visintainer P, Brzostek R, et al. Patient satisfaction with hospital care provided by hospitalists and primary care physicians. J Hosp Med. 2012;7:131-136.
2. Chen L, Birkmeyer J, Saint S, Ashish J. Hospitalist staffing and patient satisfaction in the national Medicare population. Abstract presented at HM12, April 2, 2012, San Diego.

A recent study in the Journal of Hospital Medicine that found inpatients are similarly satisfied with the care provided by hospitalists and the care of primary-care physicians (PCPs) should be considered a positive for HM, says lead author Adrianne Seiler, MD, of the Division of Healthcare Quality at Baystate Medical Center in Springfield, Mass.¹

The results are drawn from scripted patient-satisfaction telephone interviews of 8,295 patients discharged from three Massachusetts hospitals from 2003 to 2009. Starting in 2007, questions were added from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) federal quality reporting system. Multivariate-adjusted satisfaction scores for physician care quality were only slightly higher for PCPs (4.24 on a five-point scale) than for hospitalists (4.20), with no statistical difference for individual hospitals or for different hospitalist groups.

“What has been passed down as dogma is the discontinuity in care introduced by the hospitalist model,” Dr. Seiler says. But actual data on the effects of the hospitalist model on patient satisfaction are scant. “Our finding that patients essentially were equally satisfied with either model of medical care—that’s huge.”

HCAHPS scores have not been validated to evaluate patient satisfaction with individual hospitalist providers specifically, Dr. Seiler says, but they are standardized nationwide. “Is this the best way to measure patient experience?” she asks. “It’s the best tool we have at this time.”

Another wrinkle in patient satisfaction was presented as an oral research abstract at HM12. Researchers from the Veterans Administration and the University of Michigan examined the association between hospitalist staffing levels and patient satisfaction.² Hospitals with the highest hospitalist staffing had modestly higher patient satisfaction scores than those with the lowest hospitalist staffing. Overall satisfaction was 65.6 for hospitals in the highest tertile of hospitalist staffing versus 62.7 those in the lowest tertile.

References

1. Seiler A, Visintainer P, Brzostek R, et al. Patient satisfaction with hospital care provided by hospitalists and primary care physicians. J Hosp Med. 2012;7:131-136.
2. Chen L, Birkmeyer J, Saint S, Ashish J. Hospitalist staffing and patient satisfaction in the national Medicare population. Abstract presented at HM12, April 2, 2012, San Diego.

A recent study in the Journal of Hospital Medicine that found inpatients are similarly satisfied with the care provided by hospitalists and the care of primary-care physicians (PCPs) should be considered a positive for HM, says lead author Adrianne Seiler, MD, of the Division of Healthcare Quality at Baystate Medical Center in Springfield, Mass.¹

The results are drawn from scripted patient-satisfaction telephone interviews of 8,295 patients discharged from three Massachusetts hospitals from 2003 to 2009. Starting in 2007, questions were added from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) federal quality reporting system. Multivariate-adjusted satisfaction scores for physician care quality were only slightly higher for PCPs (4.24 on a five-point scale) than for hospitalists (4.20), with no statistical difference for individual hospitals or for different hospitalist groups.

“What has been passed down as dogma is the discontinuity in care introduced by the hospitalist model,” Dr. Seiler says. But actual data on the effects of the hospitalist model on patient satisfaction are scant. “Our finding that patients essentially were equally satisfied with either model of medical care—that’s huge.”

HCAHPS scores have not been validated to evaluate patient satisfaction with individual hospitalist providers specifically, Dr. Seiler says, but they are standardized nationwide. “Is this the best way to measure patient experience?” she asks. “It’s the best tool we have at this time.”

Another wrinkle in patient satisfaction was presented as an oral research abstract at HM12. Researchers from the Veterans Administration and the University of Michigan examined the association between hospitalist staffing levels and patient satisfaction.² Hospitals with the highest hospitalist staffing had modestly higher patient satisfaction scores than those with the lowest hospitalist staffing. Overall satisfaction was 65.6 for hospitals in the highest tertile of hospitalist staffing versus 62.7 those in the lowest tertile.

References

1. Seiler A, Visintainer P, Brzostek R, et al. Patient satisfaction with hospital care provided by hospitalists and primary care physicians. J Hosp Med. 2012;7:131-136.
2. Chen L, Birkmeyer J, Saint S, Ashish J. Hospitalist staffing and patient satisfaction in the national Medicare population. Abstract presented at HM12, April 2, 2012, San Diego.

Average difference in length of stay (LOS) between hospitalist groups and non-hospitalist groups, according to a meta-analysis of 17 studies of outcomes from the hospitalist approach.¹ The authors, from Cooper University Hospital in Camden, N.J., and elsewhere, searched medical literature through February 2011 for studies comparing length of stay or cost outcomes of hospitalist groups with non-hospitalist “comparator groups.” In studies comparing non-resident hospitalist services with non-resident, non-hospitalist services, LOS was shorter by 0.69 days for the hospitalist model. A total of 137,561 patients were included in the meta-analysis. No significant difference was found in cost between the hospitalist and comparison groups.

Reference

1. Rachoin JS, Skaf J, Cerceo E et al. The impact of hospitalists on length of stay and costs: Systematic review and meta-analysis. Am J Manag Care. 2012;18(1):e23-e30.

Average difference in length of stay (LOS) between hospitalist groups and non-hospitalist groups, according to a meta-analysis of 17 studies of outcomes from the hospitalist approach.¹ The authors, from Cooper University Hospital in Camden, N.J., and elsewhere, searched medical literature through February 2011 for studies comparing length of stay or cost outcomes of hospitalist groups with non-hospitalist “comparator groups.” In studies comparing non-resident hospitalist services with non-resident, non-hospitalist services, LOS was shorter by 0.69 days for the hospitalist model. A total of 137,561 patients were included in the meta-analysis. No significant difference was found in cost between the hospitalist and comparison groups.

Reference

1. Rachoin JS, Skaf J, Cerceo E et al. The impact of hospitalists on length of stay and costs: Systematic review and meta-analysis. Am J Manag Care. 2012;18(1):e23-e30.

Average difference in length of stay (LOS) between hospitalist groups and non-hospitalist groups, according to a meta-analysis of 17 studies of outcomes from the hospitalist approach.¹ The authors, from Cooper University Hospital in Camden, N.J., and elsewhere, searched medical literature through February 2011 for studies comparing length of stay or cost outcomes of hospitalist groups with non-hospitalist “comparator groups.” In studies comparing non-resident hospitalist services with non-resident, non-hospitalist services, LOS was shorter by 0.69 days for the hospitalist model. A total of 137,561 patients were included in the meta-analysis. No significant difference was found in cost between the hospitalist and comparison groups.

Reference

1. Rachoin JS, Skaf J, Cerceo E et al. The impact of hospitalists on length of stay and costs: Systematic review and meta-analysis. Am J Manag Care. 2012;18(1):e23-e30.

U.S. Department of Health and Human Services Secretary Kathleen Sebelius recently announced that the proportion of U.S. hospitals using health information technology (HIT), such as electronic health records (EHRs), has doubled in the past two years, reaching 35% in 2011, up from 16% in 2009, based on data from an American Hospital Association survey.

Nearly 2,000 hospitals and 41,000 physicians have taken advantage of $3.12 billion in EHR incentive payments from Medicare and Medicaid for ensuring meaningful use of HIT. Fully 85% of hospitals now report that they intend by 2015 to take advantage of HIT incentive payments, which were funded under the HITECH Act provisions of the American Recovery and Reinvestment Act of 2009.

The government also has created a network of 62 regional extension centers to provide technical guidance and resources. Individual HIT training is available at more than 90 community colleges and universities nationwide. For more information on the incentives, visit www.cms.gov/EHRIncentivePrograms.

A recent study of the “connected health maturity index”—systematic leveraging of HIT applications and health information exchanges—in eight countries finds the U.S. leading in several aspects of HIT use and adoption.¹ The Reston, Va., consulting firm Accenture interviewed and surveyed health-policy makers, HIT experts, and physicians in the U.S., Australia, Canada, England, France, Germany, Singapore, and Spain.

The U.S. led the way in computerized physician order entry, and 65% of its primary-care physicians (PCPs) use e-prescribing versus 20% in the other surveyed countries. Sixty-two percent of U.S. medical specialists use electronic tools to improve administrative efficiency. However, the report notes, the eight surveyed countries continue to lag behind such acknowledged HIT leaders as Denmark, Sweden, and New Zealand.

Reference

1. Accenture. U.S. among leaders in healthcare IT use and adoption, Accenture eight-country study reports. Accenture website. Available at: http://newsroom.accenture.com/news/us-among-leaders-in-healthcare-it-use-and-adoption-accenture-eight-country-study-reports.htm. Accessed March 29, 2012.

U.S. Department of Health and Human Services Secretary Kathleen Sebelius recently announced that the proportion of U.S. hospitals using health information technology (HIT), such as electronic health records (EHRs), has doubled in the past two years, reaching 35% in 2011, up from 16% in 2009, based on data from an American Hospital Association survey.

Nearly 2,000 hospitals and 41,000 physicians have taken advantage of $3.12 billion in EHR incentive payments from Medicare and Medicaid for ensuring meaningful use of HIT. Fully 85% of hospitals now report that they intend by 2015 to take advantage of HIT incentive payments, which were funded under the HITECH Act provisions of the American Recovery and Reinvestment Act of 2009.

The government also has created a network of 62 regional extension centers to provide technical guidance and resources. Individual HIT training is available at more than 90 community colleges and universities nationwide. For more information on the incentives, visit www.cms.gov/EHRIncentivePrograms.

A recent study of the “connected health maturity index”—systematic leveraging of HIT applications and health information exchanges—in eight countries finds the U.S. leading in several aspects of HIT use and adoption.¹ The Reston, Va., consulting firm Accenture interviewed and surveyed health-policy makers, HIT experts, and physicians in the U.S., Australia, Canada, England, France, Germany, Singapore, and Spain.

The U.S. led the way in computerized physician order entry, and 65% of its primary-care physicians (PCPs) use e-prescribing versus 20% in the other surveyed countries. Sixty-two percent of U.S. medical specialists use electronic tools to improve administrative efficiency. However, the report notes, the eight surveyed countries continue to lag behind such acknowledged HIT leaders as Denmark, Sweden, and New Zealand.

Reference

1. Accenture. U.S. among leaders in healthcare IT use and adoption, Accenture eight-country study reports. Accenture website. Available at: http://newsroom.accenture.com/news/us-among-leaders-in-healthcare-it-use-and-adoption-accenture-eight-country-study-reports.htm. Accessed March 29, 2012.

U.S. Department of Health and Human Services Secretary Kathleen Sebelius recently announced that the proportion of U.S. hospitals using health information technology (HIT), such as electronic health records (EHRs), has doubled in the past two years, reaching 35% in 2011, up from 16% in 2009, based on data from an American Hospital Association survey.

Nearly 2,000 hospitals and 41,000 physicians have taken advantage of $3.12 billion in EHR incentive payments from Medicare and Medicaid for ensuring meaningful use of HIT. Fully 85% of hospitals now report that they intend by 2015 to take advantage of HIT incentive payments, which were funded under the HITECH Act provisions of the American Recovery and Reinvestment Act of 2009.

The government also has created a network of 62 regional extension centers to provide technical guidance and resources. Individual HIT training is available at more than 90 community colleges and universities nationwide. For more information on the incentives, visit www.cms.gov/EHRIncentivePrograms.

A recent study of the “connected health maturity index”—systematic leveraging of HIT applications and health information exchanges—in eight countries finds the U.S. leading in several aspects of HIT use and adoption.¹ The Reston, Va., consulting firm Accenture interviewed and surveyed health-policy makers, HIT experts, and physicians in the U.S., Australia, Canada, England, France, Germany, Singapore, and Spain.

The U.S. led the way in computerized physician order entry, and 65% of its primary-care physicians (PCPs) use e-prescribing versus 20% in the other surveyed countries. Sixty-two percent of U.S. medical specialists use electronic tools to improve administrative efficiency. However, the report notes, the eight surveyed countries continue to lag behind such acknowledged HIT leaders as Denmark, Sweden, and New Zealand.

Reference

1. Accenture. U.S. among leaders in healthcare IT use and adoption, Accenture eight-country study reports. Accenture website. Available at: http://newsroom.accenture.com/news/us-among-leaders-in-healthcare-it-use-and-adoption-accenture-eight-country-study-reports.htm. Accessed March 29, 2012.

Residents can play a lead role in a program aimed at teaching commitment to the highest standards of excellence in medicine, to the welfare of patients, and to the best interests of the larger society, according to an innovations poster presentation at HM12.¹

Professionalism is important to physicians and medical trainees, says Pablo Garcia, MD, a critical-care fellow at the University of New Mexico (UNM) School of Medicine in Albuquerque and one of the project investigators who presented the results in San Diego.

“It directly impacts on patient care and the patient experience,” Dr. Garcia says. “But if we don’t police ourselves as a profession and set our own high standards, we may find that others outside of medicine will take notice.”

Academic medical centers have a particular interest in teaching professionalism to their trainees, not only because the Accreditation Council for Graduate Medical Education (ACGME) requires it, but also because of the profound impact of positive or negative examples by teachers—the “hidden curriculum”— on trainees, Dr. Garcia says.

The UNM project began with a lecture on elements of and threats to professionalism. A nine-item survey was completed by about half of the 70-member internal-medicine residency program. The results showed some less-than-ideal standards by residents. A team then met to develop nine vignettes involving real-world ethical situations, and small groups of four to six participants came together to discuss the vignettes and how they should be handled.

In some cases, attending physicians observed the groups and posed questions but did not lead the discussions, Dr. Garcia says. Over 12 months, all of the ethical scenarios were discussed at least once. Dr. Garcia was invited to speak to two other residency programs at UNM, pediatrics and emergency medicine, both of which developed their own vignettes for small-group discussion.

Reference

1. Menon R, Garcia P, Rogers K. Plugging gaps in professionalism education: a resident-generated curriculum. Abstract presented at HM12, April 2, 2012, San Diego.

Residents can play a lead role in a program aimed at teaching commitment to the highest standards of excellence in medicine, to the welfare of patients, and to the best interests of the larger society, according to an innovations poster presentation at HM12.¹

Professionalism is important to physicians and medical trainees, says Pablo Garcia, MD, a critical-care fellow at the University of New Mexico (UNM) School of Medicine in Albuquerque and one of the project investigators who presented the results in San Diego.

“It directly impacts on patient care and the patient experience,” Dr. Garcia says. “But if we don’t police ourselves as a profession and set our own high standards, we may find that others outside of medicine will take notice.”

Academic medical centers have a particular interest in teaching professionalism to their trainees, not only because the Accreditation Council for Graduate Medical Education (ACGME) requires it, but also because of the profound impact of positive or negative examples by teachers—the “hidden curriculum”— on trainees, Dr. Garcia says.

The UNM project began with a lecture on elements of and threats to professionalism. A nine-item survey was completed by about half of the 70-member internal-medicine residency program. The results showed some less-than-ideal standards by residents. A team then met to develop nine vignettes involving real-world ethical situations, and small groups of four to six participants came together to discuss the vignettes and how they should be handled.

In some cases, attending physicians observed the groups and posed questions but did not lead the discussions, Dr. Garcia says. Over 12 months, all of the ethical scenarios were discussed at least once. Dr. Garcia was invited to speak to two other residency programs at UNM, pediatrics and emergency medicine, both of which developed their own vignettes for small-group discussion.

Reference

1. Menon R, Garcia P, Rogers K. Plugging gaps in professionalism education: a resident-generated curriculum. Abstract presented at HM12, April 2, 2012, San Diego.

Residents can play a lead role in a program aimed at teaching commitment to the highest standards of excellence in medicine, to the welfare of patients, and to the best interests of the larger society, according to an innovations poster presentation at HM12.¹

Professionalism is important to physicians and medical trainees, says Pablo Garcia, MD, a critical-care fellow at the University of New Mexico (UNM) School of Medicine in Albuquerque and one of the project investigators who presented the results in San Diego.

“It directly impacts on patient care and the patient experience,” Dr. Garcia says. “But if we don’t police ourselves as a profession and set our own high standards, we may find that others outside of medicine will take notice.”

Academic medical centers have a particular interest in teaching professionalism to their trainees, not only because the Accreditation Council for Graduate Medical Education (ACGME) requires it, but also because of the profound impact of positive or negative examples by teachers—the “hidden curriculum”— on trainees, Dr. Garcia says.

The UNM project began with a lecture on elements of and threats to professionalism. A nine-item survey was completed by about half of the 70-member internal-medicine residency program. The results showed some less-than-ideal standards by residents. A team then met to develop nine vignettes involving real-world ethical situations, and small groups of four to six participants came together to discuss the vignettes and how they should be handled.

In some cases, attending physicians observed the groups and posed questions but did not lead the discussions, Dr. Garcia says. Over 12 months, all of the ethical scenarios were discussed at least once. Dr. Garcia was invited to speak to two other residency programs at UNM, pediatrics and emergency medicine, both of which developed their own vignettes for small-group discussion.

Reference

1. Menon R, Garcia P, Rogers K. Plugging gaps in professionalism education: a resident-generated curriculum. Abstract presented at HM12, April 2, 2012, San Diego.

Engaging in advance-care-planning discussions with their physicians or having advance directives filed in their medical records resulted in no significant difference in survival time for patients at three Colorado hospitals, according to a report in the Journal of Hospital Medicine.¹

A total of 458 adult patients admitted to general IM services at the hospitals were asked whether they’d had discussions with their physicians about advance directives, which are legal documents allowing patients to spell out treatment preferences (including a desire for more aggressive treatment) in advance of situations in which they are no longer able to communicate them. Charts were reviewed for the presence of advance directives, and the patients were then stratified based on low, medium, or high risk of death within a year. The high-risk patients were excluded from the study, and those in the low- and medium-risk groups were followed from 2003 to 2009.

“In regard to the current national debate about the merits of advance-care planning, this study suggests that honoring patients’ wishes to engage in advance directive discussions and documentation does not lead to harm,” the study concludes.

Lead author Stacy Fischer, MD, of the University of Colorado Denver says that it is striking how few hospitalized patients have actually engaged in these conversations, even though the population is quite ill. “So often, the conversation happens too late,” she says, “and then not with the patient but with a surrogate.”

Dr. Fischer encourages hospitalists to view the hospital admission as an important opportunity to start conversations with patients about their future care preferences. When patients come into the hospital, they must be asked about advance directives, but that process tends to be cursory, she says. At a minimum, hospitalists should clarify who the surrogate decision maker is, who would speak for the patient at a time of incapacity.

What should the hospitalist’s role be in end-of-life discussions? “That’s a complicated question in the current environment, where nobody seems to think it’s their role,” Dr. Fischer says. “I believe we all need to help move the conversation along. If [advance directive] forms can be available on the floor and if patients express interest in them, then encouraging them would be important.”

Larry Beresford is a freelance writer in Oakland, Calif.

References

1. Fischer SM, Min SJ, Sauaia A, Kutner JS. “They’re going to unplug grandma”: Advance directive discussions and documentation do not decrease survival in patients at baseline lower risk of death. J Hosp Med. 2012;7:3-7.

Engaging in advance-care-planning discussions with their physicians or having advance directives filed in their medical records resulted in no significant difference in survival time for patients at three Colorado hospitals, according to a report in the Journal of Hospital Medicine.¹

A total of 458 adult patients admitted to general IM services at the hospitals were asked whether they’d had discussions with their physicians about advance directives, which are legal documents allowing patients to spell out treatment preferences (including a desire for more aggressive treatment) in advance of situations in which they are no longer able to communicate them. Charts were reviewed for the presence of advance directives, and the patients were then stratified based on low, medium, or high risk of death within a year. The high-risk patients were excluded from the study, and those in the low- and medium-risk groups were followed from 2003 to 2009.

“In regard to the current national debate about the merits of advance-care planning, this study suggests that honoring patients’ wishes to engage in advance directive discussions and documentation does not lead to harm,” the study concludes.

Lead author Stacy Fischer, MD, of the University of Colorado Denver says that it is striking how few hospitalized patients have actually engaged in these conversations, even though the population is quite ill. “So often, the conversation happens too late,” she says, “and then not with the patient but with a surrogate.”

Dr. Fischer encourages hospitalists to view the hospital admission as an important opportunity to start conversations with patients about their future care preferences. When patients come into the hospital, they must be asked about advance directives, but that process tends to be cursory, she says. At a minimum, hospitalists should clarify who the surrogate decision maker is, who would speak for the patient at a time of incapacity.

What should the hospitalist’s role be in end-of-life discussions? “That’s a complicated question in the current environment, where nobody seems to think it’s their role,” Dr. Fischer says. “I believe we all need to help move the conversation along. If [advance directive] forms can be available on the floor and if patients express interest in them, then encouraging them would be important.”

Larry Beresford is a freelance writer in Oakland, Calif.

References

1. Fischer SM, Min SJ, Sauaia A, Kutner JS. “They’re going to unplug grandma”: Advance directive discussions and documentation do not decrease survival in patients at baseline lower risk of death. J Hosp Med. 2012;7:3-7.

Engaging in advance-care-planning discussions with their physicians or having advance directives filed in their medical records resulted in no significant difference in survival time for patients at three Colorado hospitals, according to a report in the Journal of Hospital Medicine.¹

A total of 458 adult patients admitted to general IM services at the hospitals were asked whether they’d had discussions with their physicians about advance directives, which are legal documents allowing patients to spell out treatment preferences (including a desire for more aggressive treatment) in advance of situations in which they are no longer able to communicate them. Charts were reviewed for the presence of advance directives, and the patients were then stratified based on low, medium, or high risk of death within a year. The high-risk patients were excluded from the study, and those in the low- and medium-risk groups were followed from 2003 to 2009.

“In regard to the current national debate about the merits of advance-care planning, this study suggests that honoring patients’ wishes to engage in advance directive discussions and documentation does not lead to harm,” the study concludes.

Lead author Stacy Fischer, MD, of the University of Colorado Denver says that it is striking how few hospitalized patients have actually engaged in these conversations, even though the population is quite ill. “So often, the conversation happens too late,” she says, “and then not with the patient but with a surrogate.”

Dr. Fischer encourages hospitalists to view the hospital admission as an important opportunity to start conversations with patients about their future care preferences. When patients come into the hospital, they must be asked about advance directives, but that process tends to be cursory, she says. At a minimum, hospitalists should clarify who the surrogate decision maker is, who would speak for the patient at a time of incapacity.

What should the hospitalist’s role be in end-of-life discussions? “That’s a complicated question in the current environment, where nobody seems to think it’s their role,” Dr. Fischer says. “I believe we all need to help move the conversation along. If [advance directive] forms can be available on the floor and if patients express interest in them, then encouraging them would be important.”

Larry Beresford is a freelance writer in Oakland, Calif.

References

1. Fischer SM, Min SJ, Sauaia A, Kutner JS. “They’re going to unplug grandma”: Advance directive discussions and documentation do not decrease survival in patients at baseline lower risk of death. J Hosp Med. 2012;7:3-7.

SHM has joined the American Board of Internal Medicine (ABIM) Foundation's Choosing Wisely campaign, through which medical societies identify tests and procedures that are common in their specialties but often unnecessary.

The campaign, launched in April, currently includes nine societies that have each crafted lists of "five things physicians and patients should question." SHM's Healthcare Quality and Patient Safety Committee is now working on its own evidence-based list, with a focus on the inpatient setting. The list should be released this fall, says Gregory Maynard, MD, MSc, SFHM, senior vice president of SHM’s Center for Healthcare Improvement and Innovation.

"We will also be looking for innovative methods to reinforce these messages and integrate them into daily practice," Dr. Maynard says. Unless physicians squeeze out healthcare's waste and inefficiency in ways that actually improve care, he says, "healthcare spending could be cut in potentially destructive ways."

University of California at San Francisco's Robert Wachter, MD, MHM, a co-founder of SHM who also is chair-elect of ABIM's board of directors, calls the campaign a significant advance for the quality movement, "which has not previously embraced cost and waste reduction as strongly as it needs to."

Dr. Wachter advises hospitalists take advantage of the currently available lists of questionable treatments in such areas as cardiology, radiology, and nephrology. "This is extraordinarily hopeful. The medical profession is finally stepping up to the plate," he says.

SHM has joined the American Board of Internal Medicine (ABIM) Foundation's Choosing Wisely campaign, through which medical societies identify tests and procedures that are common in their specialties but often unnecessary.

The campaign, launched in April, currently includes nine societies that have each crafted lists of "five things physicians and patients should question." SHM's Healthcare Quality and Patient Safety Committee is now working on its own evidence-based list, with a focus on the inpatient setting. The list should be released this fall, says Gregory Maynard, MD, MSc, SFHM, senior vice president of SHM’s Center for Healthcare Improvement and Innovation.

"We will also be looking for innovative methods to reinforce these messages and integrate them into daily practice," Dr. Maynard says. Unless physicians squeeze out healthcare's waste and inefficiency in ways that actually improve care, he says, "healthcare spending could be cut in potentially destructive ways."

University of California at San Francisco's Robert Wachter, MD, MHM, a co-founder of SHM who also is chair-elect of ABIM's board of directors, calls the campaign a significant advance for the quality movement, "which has not previously embraced cost and waste reduction as strongly as it needs to."

Dr. Wachter advises hospitalists take advantage of the currently available lists of questionable treatments in such areas as cardiology, radiology, and nephrology. "This is extraordinarily hopeful. The medical profession is finally stepping up to the plate," he says.

SHM has joined the American Board of Internal Medicine (ABIM) Foundation's Choosing Wisely campaign, through which medical societies identify tests and procedures that are common in their specialties but often unnecessary.

The campaign, launched in April, currently includes nine societies that have each crafted lists of "five things physicians and patients should question." SHM's Healthcare Quality and Patient Safety Committee is now working on its own evidence-based list, with a focus on the inpatient setting. The list should be released this fall, says Gregory Maynard, MD, MSc, SFHM, senior vice president of SHM’s Center for Healthcare Improvement and Innovation.

"We will also be looking for innovative methods to reinforce these messages and integrate them into daily practice," Dr. Maynard says. Unless physicians squeeze out healthcare's waste and inefficiency in ways that actually improve care, he says, "healthcare spending could be cut in potentially destructive ways."

University of California at San Francisco's Robert Wachter, MD, MHM, a co-founder of SHM who also is chair-elect of ABIM's board of directors, calls the campaign a significant advance for the quality movement, "which has not previously embraced cost and waste reduction as strongly as it needs to."

Dr. Wachter advises hospitalists take advantage of the currently available lists of questionable treatments in such areas as cardiology, radiology, and nephrology. "This is extraordinarily hopeful. The medical profession is finally stepping up to the plate," he says.