Larry Beresford

Kate Goodrich, MD, MHS, was a medical resident at George Washington University (GW) Medical Center in Washington, D.C., in 1997 when a hospitalist service there was launched. A year later, as chief resident, she was able to work as a hospitalist. She enjoyed HM so much that she stayed on at GW in a faculty position and later directed its growing division of hospital medicine.

“I absolutely loved it,” she says.

But other career interests were calling her away from her patients and working the hospital floor. Eventually, she became a key player in the health reform debate and overhaul. “I became more aware of the issues that the country was grappling with because I was seeing them on the front lines—issues such as poor access to primary care,” she says. “I began to wonder: Why does a sector of my patient population keep getting readmitted to the hospital? Why is it so difficult for them to get medications, even when they have insurance? What happens to people who have poor family support or multiple comorbidities?”

Such questions eventually became more important to her than the clinical questions she encountered. And now she is in position to make even more of a difference to patients at GW and across the country. In March 2010, Dr. Goodrich became medical officer for the Office of the Assistant Secretary for Planning and Evaluation (ASPE) in the U.S. Department of Health and Human Services (HHS). And more recently, she became senior technical advisor in the Office of Clinical Standards and Quality at the Centers for Medicare & Medicaid Services (CMS), working closely with another hospitalist leader, Patrick Conway, MD, MSc, SFHM, who recently was appointed CMS’ chief medical officer (see “Hospitalist Takes Charge,” June 2011, p. 20).

“When I started this job, I was gratified to learn that my experience as a hospitalist had unbelievable relevance,” she says. “It surprised me how often I draw upon that experience. My clinical perspective on quality is really valued.”

She retains that connection by working as a hospitalist three or four weeks a year at GW. “I now view the hospitalist world from a different lens,” she says.

Winding Path to Washington

Dr. Goodrich’s path to a health policy career didn’t happen overnight. She originally enrolled in GW’s School of Public Health, taking classes at night, but soon realized that it would take too long to obtain a public health degree that way. In 2008, the Robert Wood Johnson Clinical Scholars Program, based at Yale University, offered her an opportunity to focus more intensively on research questions. “I discovered at Yale that what was more satisfying to me was application of research into action,” she says.

Sian Spurney, MD, director of GW’s hospital medicine division, once shared an office with Dr. Goodrich. She describes Dr. Goodrich as dedicated and committed. “Although I was admittedly very sad when she left GW to pursue her passion for health policy, I was hardly surprised to hear of her successes since completing the RWJ program,” Dr. Spurney says.

During a 2009 summer internship at HHS while she was doing her Yale coursework, Dr. Goodrich worked with Dr. Conway, who was working as the ASPE medical officer at HHS. Dr. Goodrich helped write a report to Congress on the Federal Coordinating Council for Cost-Effectiveness Research (CER), and became immersed in this area of research. She worked on an interagency work group to assemble a spending plan for $400 million in federal CER allocations.

“One of the premises of CER is that it will lead to improved quality of healthcare, which we all know isn’t where it should be—in part because of uncertainty regarding best care,” she says. “We think CER will help us define best treatment in the hospital, as well as outpatient settings.” Examples, she says, would be the treatment of delirium or care for patients with multiple comorbidities. “Hospitalists are well-positioned to disseminate CER within their hospitals and to train others, actively looking for the right evidence, and applying it in practice,” she adds.

Dr. Goodrich refers to Dr. Conway as a mentor and recalls days when they would “talk about the ways the issues we were working on affect hospitalists and how to make them aware of those issues,” she says. “I found myself drawn like a magnet to the policy stuff, especially during the 2008 election. It finally dawned on me that if I love this so much, why not see if I can make it a career?”

Exciting Times for Public Servants

Dr. Goodrich acknowledges the importance of care transitions and hospital readmissions for the national quality agenda. In fact, while at Yale, she researched care transitions for patients with low health literacy.

“I doubt that any hospitalist would disagree that readmissions are bad for patients, but sometimes they feel like everyone’s looking at them when readmissions happen. As a hospitalist, you know it’s a complex problem, by no means within the control of any single hospitalist,” she says. “But we also know that some hospitals have very low readmission rates. So it can be done, and we need to learn from the high performers.”

Given the current focus on healthcare reform, Dr. Goodrich believes now is an exciting time to be working for the government. She suggests ways that other hospitalists can learn about health policy and participate in its development:

• Get involved in local quality initiatives in the hospital and the community;
• Join SHM’s Public Policy Committee;
• Follow health policy blogs, websites, and other resources offered by HHS, SHM, and private groups such as the Commonwealth Fund; and
• Look into health policy fellowships or training opportunities.

Clinical experience is highly valued throughout CMS, Dr. Conway says, noting Dr. Goodrich’s background as a teaching hospitalist with more than a decade of patient care under her belt.

“In all of CMS, there are less than a hundred physicians in total, and not all of them are still in medical practice. So we have to leverage the clinical skills of that small group. As we develop health policies, that experience gives us a greater understanding of what the policies mean—their potential impact on patients,” he says.

Larry Beresford is a freelance writer based in Oakland, Calif.

Kate Goodrich, MD, MHS, was a medical resident at George Washington University (GW) Medical Center in Washington, D.C., in 1997 when a hospitalist service there was launched. A year later, as chief resident, she was able to work as a hospitalist. She enjoyed HM so much that she stayed on at GW in a faculty position and later directed its growing division of hospital medicine.

“I absolutely loved it,” she says.

But other career interests were calling her away from her patients and working the hospital floor. Eventually, she became a key player in the health reform debate and overhaul. “I became more aware of the issues that the country was grappling with because I was seeing them on the front lines—issues such as poor access to primary care,” she says. “I began to wonder: Why does a sector of my patient population keep getting readmitted to the hospital? Why is it so difficult for them to get medications, even when they have insurance? What happens to people who have poor family support or multiple comorbidities?”

Such questions eventually became more important to her than the clinical questions she encountered. And now she is in position to make even more of a difference to patients at GW and across the country. In March 2010, Dr. Goodrich became medical officer for the Office of the Assistant Secretary for Planning and Evaluation (ASPE) in the U.S. Department of Health and Human Services (HHS). And more recently, she became senior technical advisor in the Office of Clinical Standards and Quality at the Centers for Medicare & Medicaid Services (CMS), working closely with another hospitalist leader, Patrick Conway, MD, MSc, SFHM, who recently was appointed CMS’ chief medical officer (see “Hospitalist Takes Charge,” June 2011, p. 20).

“When I started this job, I was gratified to learn that my experience as a hospitalist had unbelievable relevance,” she says. “It surprised me how often I draw upon that experience. My clinical perspective on quality is really valued.”

She retains that connection by working as a hospitalist three or four weeks a year at GW. “I now view the hospitalist world from a different lens,” she says.

Winding Path to Washington

Dr. Goodrich’s path to a health policy career didn’t happen overnight. She originally enrolled in GW’s School of Public Health, taking classes at night, but soon realized that it would take too long to obtain a public health degree that way. In 2008, the Robert Wood Johnson Clinical Scholars Program, based at Yale University, offered her an opportunity to focus more intensively on research questions. “I discovered at Yale that what was more satisfying to me was application of research into action,” she says.

Sian Spurney, MD, director of GW’s hospital medicine division, once shared an office with Dr. Goodrich. She describes Dr. Goodrich as dedicated and committed. “Although I was admittedly very sad when she left GW to pursue her passion for health policy, I was hardly surprised to hear of her successes since completing the RWJ program,” Dr. Spurney says.

During a 2009 summer internship at HHS while she was doing her Yale coursework, Dr. Goodrich worked with Dr. Conway, who was working as the ASPE medical officer at HHS. Dr. Goodrich helped write a report to Congress on the Federal Coordinating Council for Cost-Effectiveness Research (CER), and became immersed in this area of research. She worked on an interagency work group to assemble a spending plan for $400 million in federal CER allocations.

“One of the premises of CER is that it will lead to improved quality of healthcare, which we all know isn’t where it should be—in part because of uncertainty regarding best care,” she says. “We think CER will help us define best treatment in the hospital, as well as outpatient settings.” Examples, she says, would be the treatment of delirium or care for patients with multiple comorbidities. “Hospitalists are well-positioned to disseminate CER within their hospitals and to train others, actively looking for the right evidence, and applying it in practice,” she adds.

Dr. Goodrich refers to Dr. Conway as a mentor and recalls days when they would “talk about the ways the issues we were working on affect hospitalists and how to make them aware of those issues,” she says. “I found myself drawn like a magnet to the policy stuff, especially during the 2008 election. It finally dawned on me that if I love this so much, why not see if I can make it a career?”

Exciting Times for Public Servants

Dr. Goodrich acknowledges the importance of care transitions and hospital readmissions for the national quality agenda. In fact, while at Yale, she researched care transitions for patients with low health literacy.

“I doubt that any hospitalist would disagree that readmissions are bad for patients, but sometimes they feel like everyone’s looking at them when readmissions happen. As a hospitalist, you know it’s a complex problem, by no means within the control of any single hospitalist,” she says. “But we also know that some hospitals have very low readmission rates. So it can be done, and we need to learn from the high performers.”

Given the current focus on healthcare reform, Dr. Goodrich believes now is an exciting time to be working for the government. She suggests ways that other hospitalists can learn about health policy and participate in its development:

• Get involved in local quality initiatives in the hospital and the community;
• Join SHM’s Public Policy Committee;
• Follow health policy blogs, websites, and other resources offered by HHS, SHM, and private groups such as the Commonwealth Fund; and
• Look into health policy fellowships or training opportunities.

Clinical experience is highly valued throughout CMS, Dr. Conway says, noting Dr. Goodrich’s background as a teaching hospitalist with more than a decade of patient care under her belt.

“In all of CMS, there are less than a hundred physicians in total, and not all of them are still in medical practice. So we have to leverage the clinical skills of that small group. As we develop health policies, that experience gives us a greater understanding of what the policies mean—their potential impact on patients,” he says.

Larry Beresford is a freelance writer based in Oakland, Calif.

Kate Goodrich, MD, MHS, was a medical resident at George Washington University (GW) Medical Center in Washington, D.C., in 1997 when a hospitalist service there was launched. A year later, as chief resident, she was able to work as a hospitalist. She enjoyed HM so much that she stayed on at GW in a faculty position and later directed its growing division of hospital medicine.

“I absolutely loved it,” she says.

But other career interests were calling her away from her patients and working the hospital floor. Eventually, she became a key player in the health reform debate and overhaul. “I became more aware of the issues that the country was grappling with because I was seeing them on the front lines—issues such as poor access to primary care,” she says. “I began to wonder: Why does a sector of my patient population keep getting readmitted to the hospital? Why is it so difficult for them to get medications, even when they have insurance? What happens to people who have poor family support or multiple comorbidities?”

Such questions eventually became more important to her than the clinical questions she encountered. And now she is in position to make even more of a difference to patients at GW and across the country. In March 2010, Dr. Goodrich became medical officer for the Office of the Assistant Secretary for Planning and Evaluation (ASPE) in the U.S. Department of Health and Human Services (HHS). And more recently, she became senior technical advisor in the Office of Clinical Standards and Quality at the Centers for Medicare & Medicaid Services (CMS), working closely with another hospitalist leader, Patrick Conway, MD, MSc, SFHM, who recently was appointed CMS’ chief medical officer (see “Hospitalist Takes Charge,” June 2011, p. 20).

“When I started this job, I was gratified to learn that my experience as a hospitalist had unbelievable relevance,” she says. “It surprised me how often I draw upon that experience. My clinical perspective on quality is really valued.”

She retains that connection by working as a hospitalist three or four weeks a year at GW. “I now view the hospitalist world from a different lens,” she says.

Winding Path to Washington

Dr. Goodrich’s path to a health policy career didn’t happen overnight. She originally enrolled in GW’s School of Public Health, taking classes at night, but soon realized that it would take too long to obtain a public health degree that way. In 2008, the Robert Wood Johnson Clinical Scholars Program, based at Yale University, offered her an opportunity to focus more intensively on research questions. “I discovered at Yale that what was more satisfying to me was application of research into action,” she says.

Sian Spurney, MD, director of GW’s hospital medicine division, once shared an office with Dr. Goodrich. She describes Dr. Goodrich as dedicated and committed. “Although I was admittedly very sad when she left GW to pursue her passion for health policy, I was hardly surprised to hear of her successes since completing the RWJ program,” Dr. Spurney says.

During a 2009 summer internship at HHS while she was doing her Yale coursework, Dr. Goodrich worked with Dr. Conway, who was working as the ASPE medical officer at HHS. Dr. Goodrich helped write a report to Congress on the Federal Coordinating Council for Cost-Effectiveness Research (CER), and became immersed in this area of research. She worked on an interagency work group to assemble a spending plan for $400 million in federal CER allocations.

“One of the premises of CER is that it will lead to improved quality of healthcare, which we all know isn’t where it should be—in part because of uncertainty regarding best care,” she says. “We think CER will help us define best treatment in the hospital, as well as outpatient settings.” Examples, she says, would be the treatment of delirium or care for patients with multiple comorbidities. “Hospitalists are well-positioned to disseminate CER within their hospitals and to train others, actively looking for the right evidence, and applying it in practice,” she adds.

Dr. Goodrich refers to Dr. Conway as a mentor and recalls days when they would “talk about the ways the issues we were working on affect hospitalists and how to make them aware of those issues,” she says. “I found myself drawn like a magnet to the policy stuff, especially during the 2008 election. It finally dawned on me that if I love this so much, why not see if I can make it a career?”

Exciting Times for Public Servants

Dr. Goodrich acknowledges the importance of care transitions and hospital readmissions for the national quality agenda. In fact, while at Yale, she researched care transitions for patients with low health literacy.

“I doubt that any hospitalist would disagree that readmissions are bad for patients, but sometimes they feel like everyone’s looking at them when readmissions happen. As a hospitalist, you know it’s a complex problem, by no means within the control of any single hospitalist,” she says. “But we also know that some hospitals have very low readmission rates. So it can be done, and we need to learn from the high performers.”

Given the current focus on healthcare reform, Dr. Goodrich believes now is an exciting time to be working for the government. She suggests ways that other hospitalists can learn about health policy and participate in its development:

• Get involved in local quality initiatives in the hospital and the community;
• Join SHM’s Public Policy Committee;
• Follow health policy blogs, websites, and other resources offered by HHS, SHM, and private groups such as the Commonwealth Fund; and
• Look into health policy fellowships or training opportunities.

Clinical experience is highly valued throughout CMS, Dr. Conway says, noting Dr. Goodrich’s background as a teaching hospitalist with more than a decade of patient care under her belt.

“In all of CMS, there are less than a hundred physicians in total, and not all of them are still in medical practice. So we have to leverage the clinical skills of that small group. As we develop health policies, that experience gives us a greater understanding of what the policies mean—their potential impact on patients,” he says.

Larry Beresford is a freelance writer based in Oakland, Calif.

A new Health Affairs study tested three relatively simple and inexpensive interventions on a hospital unit to prevent the kinds of hospital-acquired infections that cause the deaths of an estimated 99,000 patients each year. Principal investigator Bradford Harris, MD, and colleagues conducted the research on a pediatric ICU at the University of North Carolina at Chapel Hill School of Medicine, finding that patients admitted after these interventions were implemented left the hospital on average two days earlier, at lower cost, and with a 2.3% lower death rate. Study authors projected annual savings of $12 million for a single PICU.¹

The simple measures include strict enforcement of standard hand hygiene policies; guideline-recommended measures for ventilator patients, such as elevating the head of the hospital bed; and compliance with guidelines for maintaining central line catheters, along with educational posters and the use of oral care kits.

A recent article in the “Cleveland Plain Dealer” describes efforts in that city’s hospitals to enforce proper hand hygiene.² MetroHealth Medical Center hired four employees it calls “infection prevention observers,” whose entire job is to make sure that every caregiver who comes near a patient washes his or her hands. They openly appear on the units carrying clipboards and filling out sheets tracking non-compliance.

The hospital’s hand hygiene compliance rate has reached 98% on all medical units (nationwide, the rate is around 50%), while bloodstream infections have dropped to one-third of what they were in 2010. Cleveland Clinic and University Hospitals achieved similar compliance by employing secret observers of staff hand-washing.

CDC epidemiologist and hand hygiene expert Kate Ellingson, MD, told the newspaper that while awareness of the importance of hand hygiene has long been understood, it is difficult for healthcare workers to follow. But hospitals that use employee monitors, post data, and implement other hand hygiene initiatives tend to show strong compliance.

References

1. Harris BD, Hanson H, Christy C, et al. Strict hand hygiene and other practices shortened stays and cut costs and mortality in a pediatric intensive care unit. Health Affairs. 2011;30(9):1751-1761.
2. Tribble SJ. Cleveland MetroHealth Medical Center increases hand washing, reduces infections. “Cleveland Plain Dealer” website. Available at: http://www.cleveland.com/healthfit/index.ssf/2011/09/metrohealth_increases_hand_was.html. Accessed Oct. 15, 2011.

A new Health Affairs study tested three relatively simple and inexpensive interventions on a hospital unit to prevent the kinds of hospital-acquired infections that cause the deaths of an estimated 99,000 patients each year. Principal investigator Bradford Harris, MD, and colleagues conducted the research on a pediatric ICU at the University of North Carolina at Chapel Hill School of Medicine, finding that patients admitted after these interventions were implemented left the hospital on average two days earlier, at lower cost, and with a 2.3% lower death rate. Study authors projected annual savings of $12 million for a single PICU.¹

The simple measures include strict enforcement of standard hand hygiene policies; guideline-recommended measures for ventilator patients, such as elevating the head of the hospital bed; and compliance with guidelines for maintaining central line catheters, along with educational posters and the use of oral care kits.

A recent article in the “Cleveland Plain Dealer” describes efforts in that city’s hospitals to enforce proper hand hygiene.² MetroHealth Medical Center hired four employees it calls “infection prevention observers,” whose entire job is to make sure that every caregiver who comes near a patient washes his or her hands. They openly appear on the units carrying clipboards and filling out sheets tracking non-compliance.

The hospital’s hand hygiene compliance rate has reached 98% on all medical units (nationwide, the rate is around 50%), while bloodstream infections have dropped to one-third of what they were in 2010. Cleveland Clinic and University Hospitals achieved similar compliance by employing secret observers of staff hand-washing.

CDC epidemiologist and hand hygiene expert Kate Ellingson, MD, told the newspaper that while awareness of the importance of hand hygiene has long been understood, it is difficult for healthcare workers to follow. But hospitals that use employee monitors, post data, and implement other hand hygiene initiatives tend to show strong compliance.

References

1. Harris BD, Hanson H, Christy C, et al. Strict hand hygiene and other practices shortened stays and cut costs and mortality in a pediatric intensive care unit. Health Affairs. 2011;30(9):1751-1761.
2. Tribble SJ. Cleveland MetroHealth Medical Center increases hand washing, reduces infections. “Cleveland Plain Dealer” website. Available at: http://www.cleveland.com/healthfit/index.ssf/2011/09/metrohealth_increases_hand_was.html. Accessed Oct. 15, 2011.

A new Health Affairs study tested three relatively simple and inexpensive interventions on a hospital unit to prevent the kinds of hospital-acquired infections that cause the deaths of an estimated 99,000 patients each year. Principal investigator Bradford Harris, MD, and colleagues conducted the research on a pediatric ICU at the University of North Carolina at Chapel Hill School of Medicine, finding that patients admitted after these interventions were implemented left the hospital on average two days earlier, at lower cost, and with a 2.3% lower death rate. Study authors projected annual savings of $12 million for a single PICU.¹

The simple measures include strict enforcement of standard hand hygiene policies; guideline-recommended measures for ventilator patients, such as elevating the head of the hospital bed; and compliance with guidelines for maintaining central line catheters, along with educational posters and the use of oral care kits.

A recent article in the “Cleveland Plain Dealer” describes efforts in that city’s hospitals to enforce proper hand hygiene.² MetroHealth Medical Center hired four employees it calls “infection prevention observers,” whose entire job is to make sure that every caregiver who comes near a patient washes his or her hands. They openly appear on the units carrying clipboards and filling out sheets tracking non-compliance.

The hospital’s hand hygiene compliance rate has reached 98% on all medical units (nationwide, the rate is around 50%), while bloodstream infections have dropped to one-third of what they were in 2010. Cleveland Clinic and University Hospitals achieved similar compliance by employing secret observers of staff hand-washing.

CDC epidemiologist and hand hygiene expert Kate Ellingson, MD, told the newspaper that while awareness of the importance of hand hygiene has long been understood, it is difficult for healthcare workers to follow. But hospitals that use employee monitors, post data, and implement other hand hygiene initiatives tend to show strong compliance.

References

1. Harris BD, Hanson H, Christy C, et al. Strict hand hygiene and other practices shortened stays and cut costs and mortality in a pediatric intensive care unit. Health Affairs. 2011;30(9):1751-1761.
2. Tribble SJ. Cleveland MetroHealth Medical Center increases hand washing, reduces infections. “Cleveland Plain Dealer” website. Available at: http://www.cleveland.com/healthfit/index.ssf/2011/09/metrohealth_increases_hand_was.html. Accessed Oct. 15, 2011.

The newest Dartmouth Atlas report, released Sept. 28, documents striking variation in 30-day hospital readmission rates for Medicare patients across 308 hospital-referral regions.¹ The authors found little progress in decreasing 30-day readmissions from 2004 to 2009, while for some conditions and many regions, rates actually went up.

National readmission rates following surgery were 12.7% in both 2004 and 2009; readmissions for medical conditions rose slightly, from 15.9% to 16.1%, over the same period. Only 42% of hospitalized Medicare patients discharged to home had a PCP contact within 14 days of discharge, according to the report.

The Dartmouth Atlas Project (www.dartmouthatlas.org) documents geographic variation in healthcare utilization unrelated to outcome. It offers an extensive database for comparison by state, county, region and facility.

The new report is the first to identify an association nationally between readmissions rates and “the overall intensity of inpatient care provided to patients within a region or hospital,” with patterns of relatively high hospital utilization often corresponding with areas of higher readmissions. “Other patients are readmitted simply because they live in a locale where the hospital is used more frequently as a site of care,” the authors note.

Without continuous, high-quality care coordination across sites, the authors write, discharged patients can repeatedly bounce back to emergency rooms and hospitals.

Reference

1. Goodman, DC, Fisher ES, Chang C. After Hospitalization: A Dartmouth Atlas Report on Post-Acute Care for Medicare Beneficiaries. Dartmouth Atlas website. Available at: www.dartmouthatlas.org/downloads/reports/Post_discharge_events_092811.pdf. Accessed Oct. 15, 2011.

The newest Dartmouth Atlas report, released Sept. 28, documents striking variation in 30-day hospital readmission rates for Medicare patients across 308 hospital-referral regions.¹ The authors found little progress in decreasing 30-day readmissions from 2004 to 2009, while for some conditions and many regions, rates actually went up.

National readmission rates following surgery were 12.7% in both 2004 and 2009; readmissions for medical conditions rose slightly, from 15.9% to 16.1%, over the same period. Only 42% of hospitalized Medicare patients discharged to home had a PCP contact within 14 days of discharge, according to the report.

The Dartmouth Atlas Project (www.dartmouthatlas.org) documents geographic variation in healthcare utilization unrelated to outcome. It offers an extensive database for comparison by state, county, region and facility.

The new report is the first to identify an association nationally between readmissions rates and “the overall intensity of inpatient care provided to patients within a region or hospital,” with patterns of relatively high hospital utilization often corresponding with areas of higher readmissions. “Other patients are readmitted simply because they live in a locale where the hospital is used more frequently as a site of care,” the authors note.

Without continuous, high-quality care coordination across sites, the authors write, discharged patients can repeatedly bounce back to emergency rooms and hospitals.

Reference

1. Goodman, DC, Fisher ES, Chang C. After Hospitalization: A Dartmouth Atlas Report on Post-Acute Care for Medicare Beneficiaries. Dartmouth Atlas website. Available at: www.dartmouthatlas.org/downloads/reports/Post_discharge_events_092811.pdf. Accessed Oct. 15, 2011.

The newest Dartmouth Atlas report, released Sept. 28, documents striking variation in 30-day hospital readmission rates for Medicare patients across 308 hospital-referral regions.¹ The authors found little progress in decreasing 30-day readmissions from 2004 to 2009, while for some conditions and many regions, rates actually went up.

National readmission rates following surgery were 12.7% in both 2004 and 2009; readmissions for medical conditions rose slightly, from 15.9% to 16.1%, over the same period. Only 42% of hospitalized Medicare patients discharged to home had a PCP contact within 14 days of discharge, according to the report.

The Dartmouth Atlas Project (www.dartmouthatlas.org) documents geographic variation in healthcare utilization unrelated to outcome. It offers an extensive database for comparison by state, county, region and facility.

The new report is the first to identify an association nationally between readmissions rates and “the overall intensity of inpatient care provided to patients within a region or hospital,” with patterns of relatively high hospital utilization often corresponding with areas of higher readmissions. “Other patients are readmitted simply because they live in a locale where the hospital is used more frequently as a site of care,” the authors note.

Without continuous, high-quality care coordination across sites, the authors write, discharged patients can repeatedly bounce back to emergency rooms and hospitals.

Reference

1. Goodman, DC, Fisher ES, Chang C. After Hospitalization: A Dartmouth Atlas Report on Post-Acute Care for Medicare Beneficiaries. Dartmouth Atlas website. Available at: www.dartmouthatlas.org/downloads/reports/Post_discharge_events_092811.pdf. Accessed Oct. 15, 2011.

Projected total number of adult in-hospital cardiac arrests that are treated with a resuscitation response each year in U.S. hospitals.¹ Raina Merchant, MD, and colleagues from the University of Pennsylvania Health System derived several estimates from the American Heart Association’s Get with the Guidelines-Resuscitation registry for 2003 to 2007, weighted for total U.S. hospital bed days. Survival rate for in-hospital cardiac arrests is 21%, compared with 10% for arrests in other settings. But the authors note that arrests might be rising, which is “important for understanding the burden of in-hospital cardiac arrest and developing strategies to improve care for hospitalized patients,” Dr. Merchant says.

Reference

1. Merchant RM, Yang L, Becker LB, et al. Incidence of treated cardiac arrest in hospitalized patients in the United States. Crit Care Med. 2011;39(11):2401-2406.

Projected total number of adult in-hospital cardiac arrests that are treated with a resuscitation response each year in U.S. hospitals.¹ Raina Merchant, MD, and colleagues from the University of Pennsylvania Health System derived several estimates from the American Heart Association’s Get with the Guidelines-Resuscitation registry for 2003 to 2007, weighted for total U.S. hospital bed days. Survival rate for in-hospital cardiac arrests is 21%, compared with 10% for arrests in other settings. But the authors note that arrests might be rising, which is “important for understanding the burden of in-hospital cardiac arrest and developing strategies to improve care for hospitalized patients,” Dr. Merchant says.

Reference

1. Merchant RM, Yang L, Becker LB, et al. Incidence of treated cardiac arrest in hospitalized patients in the United States. Crit Care Med. 2011;39(11):2401-2406.

Projected total number of adult in-hospital cardiac arrests that are treated with a resuscitation response each year in U.S. hospitals.¹ Raina Merchant, MD, and colleagues from the University of Pennsylvania Health System derived several estimates from the American Heart Association’s Get with the Guidelines-Resuscitation registry for 2003 to 2007, weighted for total U.S. hospital bed days. Survival rate for in-hospital cardiac arrests is 21%, compared with 10% for arrests in other settings. But the authors note that arrests might be rising, which is “important for understanding the burden of in-hospital cardiac arrest and developing strategies to improve care for hospitalized patients,” Dr. Merchant says.

Reference

1. Merchant RM, Yang L, Becker LB, et al. Incidence of treated cardiac arrest in hospitalized patients in the United States. Crit Care Med. 2011;39(11):2401-2406.

Michele Torres, MD, a family-medicine-trained hospitalist at Good Samaritan Hospital in Dayton, Ohio, wanted to diversify her medical practice. So she created Youthinity, a cosmetic spa that utilizes laser lipolysis to sculpt, slim, and contour women’s bodies.

Launched in September following 18 months of business planning, the spa includes other cosmetic treatments, such as Botox and Juvederm, for wrinkles in a relaxed spa environment. The business employs a full-time office manager and a per-diem nurse to help with procedures.

“I love hospital medicine and don’t want to leave it, but I don’t want to have all my eggs in one basket, either,” Dr. Torres says.

Dr. Torres has been a hospitalist for five years and founded an HM program at another hospital. But hospital mergers, the uncertainties of healthcare reform, and hospitalist scheduling demands made her want to establish a second medical practice that didn’t tie her down to as many hospital shifts. She currently works a seven-on, seven-off HM schedule, and is able to schedule laser procedures during the off weeks or after hours. She also hopes to reduce her HM hours as the business grows.

Another driving force behind the business was the desire as a female physician to offer procedures that are primarily—although not exclusively—sought by women.

"It's really a very different experience than hospital medicine. You need to enjoy doing procedures," she adds. "In a business like this, it's also very market-driven and hands-on. People having the procedures done want to know their doctors. If someone is paying for this procedure, they want to feel pampered."

Michele Torres, MD, a family-medicine-trained hospitalist at Good Samaritan Hospital in Dayton, Ohio, wanted to diversify her medical practice. So she created Youthinity, a cosmetic spa that utilizes laser lipolysis to sculpt, slim, and contour women’s bodies.

Launched in September following 18 months of business planning, the spa includes other cosmetic treatments, such as Botox and Juvederm, for wrinkles in a relaxed spa environment. The business employs a full-time office manager and a per-diem nurse to help with procedures.

“I love hospital medicine and don’t want to leave it, but I don’t want to have all my eggs in one basket, either,” Dr. Torres says.

Dr. Torres has been a hospitalist for five years and founded an HM program at another hospital. But hospital mergers, the uncertainties of healthcare reform, and hospitalist scheduling demands made her want to establish a second medical practice that didn’t tie her down to as many hospital shifts. She currently works a seven-on, seven-off HM schedule, and is able to schedule laser procedures during the off weeks or after hours. She also hopes to reduce her HM hours as the business grows.

Another driving force behind the business was the desire as a female physician to offer procedures that are primarily—although not exclusively—sought by women.

"It's really a very different experience than hospital medicine. You need to enjoy doing procedures," she adds. "In a business like this, it's also very market-driven and hands-on. People having the procedures done want to know their doctors. If someone is paying for this procedure, they want to feel pampered."

Michele Torres, MD, a family-medicine-trained hospitalist at Good Samaritan Hospital in Dayton, Ohio, wanted to diversify her medical practice. So she created Youthinity, a cosmetic spa that utilizes laser lipolysis to sculpt, slim, and contour women’s bodies.

Launched in September following 18 months of business planning, the spa includes other cosmetic treatments, such as Botox and Juvederm, for wrinkles in a relaxed spa environment. The business employs a full-time office manager and a per-diem nurse to help with procedures.

“I love hospital medicine and don’t want to leave it, but I don’t want to have all my eggs in one basket, either,” Dr. Torres says.

Dr. Torres has been a hospitalist for five years and founded an HM program at another hospital. But hospital mergers, the uncertainties of healthcare reform, and hospitalist scheduling demands made her want to establish a second medical practice that didn’t tie her down to as many hospital shifts. She currently works a seven-on, seven-off HM schedule, and is able to schedule laser procedures during the off weeks or after hours. She also hopes to reduce her HM hours as the business grows.

Another driving force behind the business was the desire as a female physician to offer procedures that are primarily—although not exclusively—sought by women.

"It's really a very different experience than hospital medicine. You need to enjoy doing procedures," she adds. "In a business like this, it's also very market-driven and hands-on. People having the procedures done want to know their doctors. If someone is paying for this procedure, they want to feel pampered."

A partnership with nearly 400 local churches is helping the seven-hospital Methodist Le Bonheur Healthcare System, based in Memphis, Tenn., return hospitalized patients to their communities with the support they need to manage such chronic conditions as congestive heart failure.

Preliminary research into the Congregational Health Network shows a 20% decrease in readmissions by participating patients, compared with matched controls, says Teresa Cutts, PhD, director of research for innovation for Methodist's Center of Excellence in Faith & Health.

But the program is more than just "outreach" from the health system to the churches, she adds. It also is "in-reach" from community partners to the health system and a true collaboration. "The clergy have a covenant; they have deep ownership of this network," she says.

Trained volunteer liaisons at each participating church are the bridge to the health system. Patients who are members of the network and who opt in at admission are connected to liaisons or other church volunteers, who then visit patients in the hospital and at their homes following discharge. Hospital-employed community care workers (called navigators) help coordinate these connections, supported by Methodist's electronic health record (EHR).

The network has 12,000 registered members. Approximately 1,100 volunteers have received training in such subjects as hospital visitation, hands-on aftercare, and mental health first aid. Larger goals, Dr. Cutts says, include pushing this support further upstream into preventive care, documenting outcomes, and incorporating more clinical issues into the volunteer training.

"We think it's time, and will really empower people," she says.

In September, health system representatives visited the White House to share the coalition's success story. For more information, contact Cutts at [email protected].

A partnership with nearly 400 local churches is helping the seven-hospital Methodist Le Bonheur Healthcare System, based in Memphis, Tenn., return hospitalized patients to their communities with the support they need to manage such chronic conditions as congestive heart failure.

Preliminary research into the Congregational Health Network shows a 20% decrease in readmissions by participating patients, compared with matched controls, says Teresa Cutts, PhD, director of research for innovation for Methodist's Center of Excellence in Faith & Health.

But the program is more than just "outreach" from the health system to the churches, she adds. It also is "in-reach" from community partners to the health system and a true collaboration. "The clergy have a covenant; they have deep ownership of this network," she says.

Trained volunteer liaisons at each participating church are the bridge to the health system. Patients who are members of the network and who opt in at admission are connected to liaisons or other church volunteers, who then visit patients in the hospital and at their homes following discharge. Hospital-employed community care workers (called navigators) help coordinate these connections, supported by Methodist's electronic health record (EHR).

The network has 12,000 registered members. Approximately 1,100 volunteers have received training in such subjects as hospital visitation, hands-on aftercare, and mental health first aid. Larger goals, Dr. Cutts says, include pushing this support further upstream into preventive care, documenting outcomes, and incorporating more clinical issues into the volunteer training.

"We think it's time, and will really empower people," she says.

In September, health system representatives visited the White House to share the coalition's success story. For more information, contact Cutts at [email protected].

A partnership with nearly 400 local churches is helping the seven-hospital Methodist Le Bonheur Healthcare System, based in Memphis, Tenn., return hospitalized patients to their communities with the support they need to manage such chronic conditions as congestive heart failure.

Preliminary research into the Congregational Health Network shows a 20% decrease in readmissions by participating patients, compared with matched controls, says Teresa Cutts, PhD, director of research for innovation for Methodist's Center of Excellence in Faith & Health.

But the program is more than just "outreach" from the health system to the churches, she adds. It also is "in-reach" from community partners to the health system and a true collaboration. "The clergy have a covenant; they have deep ownership of this network," she says.

Trained volunteer liaisons at each participating church are the bridge to the health system. Patients who are members of the network and who opt in at admission are connected to liaisons or other church volunteers, who then visit patients in the hospital and at their homes following discharge. Hospital-employed community care workers (called navigators) help coordinate these connections, supported by Methodist's electronic health record (EHR).

The network has 12,000 registered members. Approximately 1,100 volunteers have received training in such subjects as hospital visitation, hands-on aftercare, and mental health first aid. Larger goals, Dr. Cutts says, include pushing this support further upstream into preventive care, documenting outcomes, and incorporating more clinical issues into the volunteer training.

"We think it's time, and will really empower people," she says.

In September, health system representatives visited the White House to share the coalition's success story. For more information, contact Cutts at [email protected].

A new study evaluating outcomes for hospitals participating in the American Heart Association’s Get with the Guidelines program found no correlation between high performance on adhering to measures and care standards for acute myocardial infarction and for heart failure despite overlap between the sets of care processes (J Am Coll Cardio. 2011;58:637-644).

A total of 400,000 heart patients were studied, and 283 participating hospitals were stratified into thirds based on their adherence to core quality measures for each disease, with the upper third labeled superior in performance. Lead author Tracy Wang, MD, MHS, MSc, of the Duke Clinical Research Institute in Durham, N.C., and colleagues found that superior performance for only one of the two diseases led to such end-result outcomes as in-hospital mortality that were no better than for hospitals that were not high performers for either condition. But hospitals with superior performance for both conditions had lower in-hospital mortality rates.

“Perhaps quality is more than just following checklists,” Dr. Wang says. “There’s something special about these high-performing hospitals across the board, with better QI, perhaps a little more investment in infrastructure for quality.”

This result, Dr. Wang says, should give ammunition for hospitalists and other physicians to go to their hospital administrators to request more investment in quality improvement overall, not just for specific conditions.

A new study evaluating outcomes for hospitals participating in the American Heart Association’s Get with the Guidelines program found no correlation between high performance on adhering to measures and care standards for acute myocardial infarction and for heart failure despite overlap between the sets of care processes (J Am Coll Cardio. 2011;58:637-644).

A total of 400,000 heart patients were studied, and 283 participating hospitals were stratified into thirds based on their adherence to core quality measures for each disease, with the upper third labeled superior in performance. Lead author Tracy Wang, MD, MHS, MSc, of the Duke Clinical Research Institute in Durham, N.C., and colleagues found that superior performance for only one of the two diseases led to such end-result outcomes as in-hospital mortality that were no better than for hospitals that were not high performers for either condition. But hospitals with superior performance for both conditions had lower in-hospital mortality rates.

“Perhaps quality is more than just following checklists,” Dr. Wang says. “There’s something special about these high-performing hospitals across the board, with better QI, perhaps a little more investment in infrastructure for quality.”

This result, Dr. Wang says, should give ammunition for hospitalists and other physicians to go to their hospital administrators to request more investment in quality improvement overall, not just for specific conditions.

A new study evaluating outcomes for hospitals participating in the American Heart Association’s Get with the Guidelines program found no correlation between high performance on adhering to measures and care standards for acute myocardial infarction and for heart failure despite overlap between the sets of care processes (J Am Coll Cardio. 2011;58:637-644).

A total of 400,000 heart patients were studied, and 283 participating hospitals were stratified into thirds based on their adherence to core quality measures for each disease, with the upper third labeled superior in performance. Lead author Tracy Wang, MD, MHS, MSc, of the Duke Clinical Research Institute in Durham, N.C., and colleagues found that superior performance for only one of the two diseases led to such end-result outcomes as in-hospital mortality that were no better than for hospitals that were not high performers for either condition. But hospitals with superior performance for both conditions had lower in-hospital mortality rates.

“Perhaps quality is more than just following checklists,” Dr. Wang says. “There’s something special about these high-performing hospitals across the board, with better QI, perhaps a little more investment in infrastructure for quality.”

This result, Dr. Wang says, should give ammunition for hospitalists and other physicians to go to their hospital administrators to request more investment in quality improvement overall, not just for specific conditions.

Robert Wood Johnson University Hospital in Hamilton, N.J., has partnered with Jewish Family and Children’s Services of Greater Mercer County to support care transitions for 350 chronically ill older patients. Patients will receive a transitions coach following hospital discharge for education, support, and encouragement to keep appointments with their physicians. This “coach” will develop a plan of care for the patient, making one hospital visit, one home visit, and three phone calls, says Joyce Schwarz, the hospital’s vice president of quality and the project’s director.

The hospital received a $300,000 grant under the New Jersey Health Initiative from the Robert Wood Johnson Foundation to use an evidence-based intervention to improve care transitions and reduce readmissions, acting as a bridge between hospital personnel and community physicians.

Robert Wood Johnson University Hospital in Hamilton, N.J., has partnered with Jewish Family and Children’s Services of Greater Mercer County to support care transitions for 350 chronically ill older patients. Patients will receive a transitions coach following hospital discharge for education, support, and encouragement to keep appointments with their physicians. This “coach” will develop a plan of care for the patient, making one hospital visit, one home visit, and three phone calls, says Joyce Schwarz, the hospital’s vice president of quality and the project’s director.

The hospital received a $300,000 grant under the New Jersey Health Initiative from the Robert Wood Johnson Foundation to use an evidence-based intervention to improve care transitions and reduce readmissions, acting as a bridge between hospital personnel and community physicians.

Robert Wood Johnson University Hospital in Hamilton, N.J., has partnered with Jewish Family and Children’s Services of Greater Mercer County to support care transitions for 350 chronically ill older patients. Patients will receive a transitions coach following hospital discharge for education, support, and encouragement to keep appointments with their physicians. This “coach” will develop a plan of care for the patient, making one hospital visit, one home visit, and three phone calls, says Joyce Schwarz, the hospital’s vice president of quality and the project’s director.

The hospital received a $300,000 grant under the New Jersey Health Initiative from the Robert Wood Johnson Foundation to use an evidence-based intervention to improve care transitions and reduce readmissions, acting as a bridge between hospital personnel and community physicians.

A report published online May 24 in the Journal of Hospital Medicine found that smoothing inpatient occupancy and scheduled admissions in 39 children’s hospitals helped reduce midweek overcrowding. Evan S. Fieldston, MD, MBA, MSHP, of the University of Pennsylvania School of Medicine in Philadelphia and colleagues previously demonstrated occupancy variability and midweek crowding weekends (J Hosp Med. 2011;6:81-87). Strategies the team studied included controlling admissions when possible to achieve more level occupancy, with a mean of 2.6% of admissions moved to a different day of the week.

A report published online May 24 in the Journal of Hospital Medicine found that smoothing inpatient occupancy and scheduled admissions in 39 children’s hospitals helped reduce midweek overcrowding. Evan S. Fieldston, MD, MBA, MSHP, of the University of Pennsylvania School of Medicine in Philadelphia and colleagues previously demonstrated occupancy variability and midweek crowding weekends (J Hosp Med. 2011;6:81-87). Strategies the team studied included controlling admissions when possible to achieve more level occupancy, with a mean of 2.6% of admissions moved to a different day of the week.

A report published online May 24 in the Journal of Hospital Medicine found that smoothing inpatient occupancy and scheduled admissions in 39 children’s hospitals helped reduce midweek overcrowding. Evan S. Fieldston, MD, MBA, MSHP, of the University of Pennsylvania School of Medicine in Philadelphia and colleagues previously demonstrated occupancy variability and midweek crowding weekends (J Hosp Med. 2011;6:81-87). Strategies the team studied included controlling admissions when possible to achieve more level occupancy, with a mean of 2.6% of admissions moved to a different day of the week.

A sking “teachback” questions to hospitalized chronic heart failure (CHF) patients at Lehigh Valley Health Network in Allentown, Pa., helps them better understand their condition, treatment, and post-discharge care—thereby impacting readmissions. In an abstract presented at HM11 in Dallas in May, CHF patients who received teachback had a 7.3% readmission rate in the first three months of 2011, compared with 9.7% for those who did not.

Teachback, according to hospitalist and lead author Michael Pistoria, DO, FACP, SFHM, represents “humble inquiry—the simple need and ability to ask patients: ‘Can you tell me what I said to you?’” The provider then needs to listen to the reply and confirm the understanding, he adds.

Lehigh Valley convened a multidisciplinary quality team to study transitions of care, with a subgroup focused on patient-caregiver education, Dr. Pistoria explains. “The first thing the patient-family caregiver education team looked at was how to identify the key learner,” he says. “We had assumed it was the patient, but that’s not always the person who needs to learn about managing the patient’s condition.”

The subgroup then developed a curriculum of questions to be asked sequentially over three days to test patients and their caregivers’ understanding of heart failure and need for reinforcement. These questions, drawing upon educational resources already used within the system, assess the key learner’s knowledge, attitudes about healthy behaviors, and how to incorporate those behaviors into effective self-care.

The teachback system was tested on a few patients, then disseminated to 1,400 nurses through Lehigh Valley’s professional e-learning network using a brief training video. “We learned that doing a good job of staff teaching is not enough, unless we go back and periodically revisit the issues and audit their performance,” Dr. Pistoria says. “In our system, starting with our nurses was the right approach. It’s important for everybody to take ownership of the initiative. It’s also important, from unit to unit, to ask the questions the same way.”

Subsequent analysis shows continued reductions in readmissions, Dr. Pistoria says. Lehigh Valley’s next targets for teachback are community-acquired pneumonia, myocardial infarction, hypoglycemia, COPD, and anti-coagulant treatment.

A sking “teachback” questions to hospitalized chronic heart failure (CHF) patients at Lehigh Valley Health Network in Allentown, Pa., helps them better understand their condition, treatment, and post-discharge care—thereby impacting readmissions. In an abstract presented at HM11 in Dallas in May, CHF patients who received teachback had a 7.3% readmission rate in the first three months of 2011, compared with 9.7% for those who did not.

Teachback, according to hospitalist and lead author Michael Pistoria, DO, FACP, SFHM, represents “humble inquiry—the simple need and ability to ask patients: ‘Can you tell me what I said to you?’” The provider then needs to listen to the reply and confirm the understanding, he adds.

Lehigh Valley convened a multidisciplinary quality team to study transitions of care, with a subgroup focused on patient-caregiver education, Dr. Pistoria explains. “The first thing the patient-family caregiver education team looked at was how to identify the key learner,” he says. “We had assumed it was the patient, but that’s not always the person who needs to learn about managing the patient’s condition.”

The subgroup then developed a curriculum of questions to be asked sequentially over three days to test patients and their caregivers’ understanding of heart failure and need for reinforcement. These questions, drawing upon educational resources already used within the system, assess the key learner’s knowledge, attitudes about healthy behaviors, and how to incorporate those behaviors into effective self-care.

The teachback system was tested on a few patients, then disseminated to 1,400 nurses through Lehigh Valley’s professional e-learning network using a brief training video. “We learned that doing a good job of staff teaching is not enough, unless we go back and periodically revisit the issues and audit their performance,” Dr. Pistoria says. “In our system, starting with our nurses was the right approach. It’s important for everybody to take ownership of the initiative. It’s also important, from unit to unit, to ask the questions the same way.”

Subsequent analysis shows continued reductions in readmissions, Dr. Pistoria says. Lehigh Valley’s next targets for teachback are community-acquired pneumonia, myocardial infarction, hypoglycemia, COPD, and anti-coagulant treatment.

A sking “teachback” questions to hospitalized chronic heart failure (CHF) patients at Lehigh Valley Health Network in Allentown, Pa., helps them better understand their condition, treatment, and post-discharge care—thereby impacting readmissions. In an abstract presented at HM11 in Dallas in May, CHF patients who received teachback had a 7.3% readmission rate in the first three months of 2011, compared with 9.7% for those who did not.

Teachback, according to hospitalist and lead author Michael Pistoria, DO, FACP, SFHM, represents “humble inquiry—the simple need and ability to ask patients: ‘Can you tell me what I said to you?’” The provider then needs to listen to the reply and confirm the understanding, he adds.

Lehigh Valley convened a multidisciplinary quality team to study transitions of care, with a subgroup focused on patient-caregiver education, Dr. Pistoria explains. “The first thing the patient-family caregiver education team looked at was how to identify the key learner,” he says. “We had assumed it was the patient, but that’s not always the person who needs to learn about managing the patient’s condition.”

The subgroup then developed a curriculum of questions to be asked sequentially over three days to test patients and their caregivers’ understanding of heart failure and need for reinforcement. These questions, drawing upon educational resources already used within the system, assess the key learner’s knowledge, attitudes about healthy behaviors, and how to incorporate those behaviors into effective self-care.

The teachback system was tested on a few patients, then disseminated to 1,400 nurses through Lehigh Valley’s professional e-learning network using a brief training video. “We learned that doing a good job of staff teaching is not enough, unless we go back and periodically revisit the issues and audit their performance,” Dr. Pistoria says. “In our system, starting with our nurses was the right approach. It’s important for everybody to take ownership of the initiative. It’s also important, from unit to unit, to ask the questions the same way.”

Subsequent analysis shows continued reductions in readmissions, Dr. Pistoria says. Lehigh Valley’s next targets for teachback are community-acquired pneumonia, myocardial infarction, hypoglycemia, COPD, and anti-coagulant treatment.